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CITY OF PALM SPRINGS PUBLIC INTEGRITY DISCLOSURE
Why Must I File?
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When Must I File?
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PUBLIC INTEGRITY DISCLOSURE REPORT
Name (Print last, first, middle initial)E-mail Address
Position/Title
Address
Work Phone Reporting Status
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If New Official, Date of Election or
Appointment:
(mm/dd/yy)
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Organization:
(include the address, city and state where the the organization is located)
Type of organization:Position:No
longer
held:
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Property Address:Type of Property:Term of Rental
Agreement/
Lease:
No
longer
held:
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I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of Disclosing Party Date
On the basis of information contained in this report, I conclude that the filer is in compliance
with Palm Springs Municipal Code Section 2.60, except as noteGLQWKH³FRPPeQWV´ER[
below.
Comments:
Signature and Title of AJHQF\¶V)LQDO Review ing Official
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