HomeMy WebLinkAbout803 Robert Moon 2019-10-03 Palm Springs Modernism WeekBehested Payment Report
REC EI V ED
A PQljli't ~e~rftPRINGS
1. Elected Officer or CPUC Member (Last name, First name)ZOl 9 OCT : 3 M 12:03~Stamp
Robert Moon
A gency Name
City of Palm Springs
OFFIC E OF THE ITY CLE Rt·
Agency S treet Add ress
3200 E Tahq uitz Canyon Way, Palm Spri ngs CA 92262
Behested Payment Report
California 803
Form
For Official Use Only
Designated Contact Person (Na me and ti tle , if different)
Anthony Mejia , Ci ty Clerk, City of Palm Springs
0 Amendment (See Part 5)
Area Code/Pho ne Number
760.832.8200
E -mail (Optional)
robert.moon@palmspringsca .gov
Date of Original Filing: --,-.....,.,..-,---,--
(month, day. year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Palm Sp rings Modernism Week
Name
PO Box 5001 Palm Springs
Address City
3. Payee Information (For additional p ayees. include an attachmen t with the names and addresses.)
City of Palm Springs
Name
3200 E Tahquitz Canyon Way Palm Springs
Address City
4 . Payment Information (Complete all info""alion.}
CA 92263
State Zip Code
CA 92262
State Zip Code
Date of Paym ent: Sept 29 , 201 9
(month, day. year}
100 000 Amount of Paym ent: (ln-Kind F MVJ $ __ • ________ _
(Round to whole dolla rs.)
Payment Type: IB] Monetary Donation o r D In-Kind Goods or Services (Provide descripr,on below.)
B r i ef Description of In -Kind Payme nt: ------------------------------
Pu rpose : (Check one and provide description below.) D Legis lative 0 Govern mental IBl Charitable
Describe the legislative, governmental, charitable purpose, o r event: Donation to the Fund Raisi ng Effort
to fund the preservation of the h istoric Palm Springs Plaza Theatre, a city owned property.
5 . Amendme nt Description and/or Comments
6 . Verification
I certify , under penalty of perjury under the l aw s of the State o
he rei n is true and complete.
Executed on ____ o_c_t _3_, 2_0_1_9 __ _
DATE
FPPC Form 803 (Jan uary/2018)
FPPC Toll-Free Helplin e: 866/ASK-FPPC (866/275-3772)