803 Robert Moon 2019-09-19 Harold MatznerBehested Payment Report A Public D
1. Elected Officer or CPUC Member (Last name, First name) Date Stamp
Moon , Robert 2019 EP 19 PH 12: 56
-:-A-g-en_c_y__,N,.,.a_m_e--------------------------1
City of Palm Springs OFFICE OF THE CI TY CLE Rr
Agency Street Address
3200 E. Tahquitz Canyon Way, Palm Springs CA 92262
De si g nate d Co ntact Pe rs o n (Name and title, if different) 0 A men dment (See Part 5)
Area Co de/Ph o ne Numb e r
7603238200
E-mail (Optional)
robert.moon@palmspringsca.gov
Date of Origina l Fi ling: --,--,--,---,--
(month, day, year)
2. Payor Information (For additional payors, incl ude an attachment with the names and addresses.)
Harold Matzner
Name
181 S , C ivic Drive Suite 1 Palm Springs
Address City
3. Payee I nformation (For additional payees, include an attachment with the names and addresses.)
American Legion Post 519
Name
400 N . Belardo Road Palm Springs
Address Ci ty
CA 92262
State Zlp Code
CA 92262
State Zlp Code
4 . Payment Information (Complele al/information.)
8/2 3/2019 Da te of Payme nt: ______ _
(month, day, year)
5999.00 Amo unt of Pa ymen t: (tn-Kind FMV/ $ ---,-=--___,..,--,-,-_,....,,.--,---
(Round to whole dollars./
Pa ym ent Typ e : [gJ M o netary Donation or D In-Kind Goods or Services (Provide description below./
Bri ef Descripti on of In -Ki nd Payme nt: ------------------------------
PU rpose : (Check one and provide description below.) D Legis lative D Governmental ~ Charitable
Describe the leg islative, governmental , charitable purpose, or event: D onated f unds to pay for the labor
for the pa int ing of the Palm Springs American Legion, a 501c3 organ ization .
5. Amendment Description and/or Comments
6 . Verification
I certify, under pena lty of pe~ury under the laws of t he Sta
herein is true and complete .
Executed on ___ s_e_p_t _19_,_2_0_1_9 __ _
DATE
FPP C Fo rm 803 (January/201 8 )
FPPC To ll-Free He lpl i ne: 866/ASK-FPPC (866/275-3772)