HomeMy WebLinkAbout803 Robert Moon 2019-10-03 Palm Springs Preservation FoundationBehested Payment Report
1. Elected Officer or CPUC Member (Last name, First name)
Robert Moon 2019 OCT :3
Ag ency Name
Behested Payment Report
California 803
Form
For Official Use Only
City of Palm Springs OF FICE OF THE C TY CLE R:
Agency Street Address
3200 E Tahq uitz Canyon Way, Palm Springs CA 92262
Designated Contact Person (Name a nd title, if different)
Anthony Mej ia , City Clerk, City of Palm Springs
Area Code/Phone Number
760.832.8200
E-mail (Optional)
robert. moon@palmspringsca.gov
D Amendment /See Part SJ
Date of Original Filing:-~--,--,---,--
(month, day. year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Palm Springs Preservation Foundation
Name
1775 E Palm Canyon Drive Sui te 110-195 Palm Springs CA 92 264
Address City State Zip Code
3. Payee Information (For additiona l p ayees. include an attachment with the names and addresses.)
City of Palm Springs
Name
3200 E Tahqu itz Canyon Way Palm Springs CA 92262
Address City State Zip Code
4. Payment Information (Complete all information.)
Date of Paym ent: June 6 , 2019
/mo nth, day. year)
50 000 Amount of Payment: /ln-Kin dFMVJ $ __ , ...,.,,.-.,---,-,........,.-,,-----
/Ro und to whole dollars.)
Payment Type : IE] Monetary Donation or • In-Kind Goods or Services (Provide description below.)
Brief Description of In-Kind Payment: ------------------------------
Purpose: (C heck one and provide description below.) D Legislative D Governmental IE) Cha ritable
Describe th e legislative, governmental, c haritable purpose, or event: Donation to th e Fund Raising Effort
to fund th e preservation of the historic Pa lm Springs P laza Theatre , a city owned property.
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of perjury under the law s of the Sta
he re in is true and complete.
Executed on ____ o_c_t _3_, 2_0_1_9 __ _
DATE
t of my knowledge , th e in form a tion con tained
FPPC Fo rm 803 (January/2018)
FPPC To ll-Fr ee He lplin e: 866/ASK-FPPC (866/275-3772)