803 Christy Gilbert Holstege 2019-09-08 Douglas MorelandDertesieO Yayn-1 i Kepon A YUDIIC LJOCI1M
IVIED eehested Payment Report
1. Elected Officer Or CPUC Member (last name, First name) Ul I T Ut I`
ALM oVeRAPS
• e 1
Christy Gilbert Holstege
8 PM 5: 27
For Official Use Only
Agency Name
City of Palm Springs OFFICE
HE CITY CLERi
Agency Street Address
3200 E Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (see Part 5)
Christy Gilbert Holstege
Date of Original Filing:
(morrth, day, year)
Area Code/Phone Number
E-mail (Optional)
(760) 323-8299
christy.holstege@palmspringsca.gov
2. Payor Information (For additional payors. include an attachment with the names and addmsses.i
Douglas Moreland
10865 Savona Road Los Angeles CA 90077
Address city state zip code
3. Payee Information (For additional payees, include an alachment with the names and addresses.)
Equality California
3701 Wilshire Blvd, Suite 725 Los Angeles CA 90010
Addmss city state zip code
4. Payment Information (completeaNbbormatdn.)
Date of Payment: 8/14/2019 Amount of Payment: (iJondtmv) $ 5,000
(month, day, year) (Round to whale dollars.)
Payment Type: ® Monetary Donation or ❑ In -Kind Goods or Services (Provide description Below)
Brief Description of In -Kind Payment:
Purpose: (Check one and o ovids description below) ❑ Legislative ❑ Governmental ® Charitable
Describe the legislative, governmental, charitable purpose, or event: Equality California Palm Springs Awards
event to take place in October 2019
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of perjury under the laws of the State of California, that to the best of my knowledge, the information contained
herein is true and complete.
Executed on 9/9/2019 By
DATE aIGNATIJRE ELECTE OFFI ER CPUC MEMBER
FPPC Form 803I(January/2018)
FPPCToll-Free Helpline: 866/ASK-FPPt% (866/275-3772)