HomeMy WebLinkAbout803 Robert Moon 2019-11-04 Suzanne Somers and Alan HamelBehested Payment Report
nECEIV ED
A PUbIj )g0fflR",j SPRINGS genestea Payment Report
1. Elected Officer or CPUC Member(Lastname, First name)
4 P�IPaf�S(y
' • 1
Robert Moon, Mayor 2p19 NOd
CITY CItr,;.
HE CITY
•
For Official Use Only
Agency Name
OFFICE
City of Palm prings
Agency Street Address
3200 E. Tahquitz Canyon Way, Palm Springs, CA
Designated Contact Person (Name and title, ifdiNerenq
❑ Amendment Part
Anthony Melia, City Clerk, City of Palm Springs
(See 5)
Date of original Filing:
Area CodelPhone Number
E-mail (optional)
760 323-8206
( )
Anthony.e is
y. j @palmspringsca.gov
(month, day, year)
2. Payor Information (For additional peyors, include an attachment with the names and addresses.)
Suzanne Somers and Alan Hamel
433 S. Beverly Hills Drive
Beverly Hills
CA 90212
ACUMSS City state Zip Cade
3. Payee Information (For additional payees. include an attachment with the names and addresses)
City of Palm Springs Walk of Stars
3200 E. Tahquitz Canyon Way Palm Springs CA 92262
Address City Slate Zip Code
4. Payment Information (Competeaninformanonl
Date of Payment: 10/14/2019 Amount of Payment: (tn wwFMv $ 5,000
(month, day, year) (Round to whole dollars)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services(pmvide descdption below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below) ❑Legislative ❑Governmental 0Charitable
Describe the legislative, governmental, charitable purpose, or event: Donation toward Walk of Star
Dedication for local Radio Host Bill Feingold and following reception at LULU California Bistro.
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of perjury under the laws of thrte of California, that O a best of my knowledge, the information contained
herein is true and complete.
Executed on Oct 31, 2019 By
DATE SIGNATURE OF ELECTED OFFlCER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (966/275-3772)