HomeMy Public PortalAbout11-06-19 - Davis-Holmes, Lula (4)Behested Payment Report A Public Document Behested Payment Report
1. Elected Officer or
Lula Davis Holmes
City of Carson
701 E.. Carson Street
(Last name, First name)
(Name and title, if different)
Area Code/Phone Number -mail (Optional)
310 629-9158
2. Payor Information (Foredditional
Shen Oil
include an attachment with the names
CHT
Nov -b PM 2* -
CITY OF CARSO
[] Amendment (See Part 5)
For Offidal Use Only
Date of Original Filing:
(month, day, year)
addresses.)
20945 S. Wilmington Carson CA 90810
Address city State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Carson Citizen Cultural Arts Foundation
Name
P.O. Box 4573 Carson Calif 90745
Address City State Zip Code
4. Payment Information (Complefeall information.)
Date of Payment.&9al.2019 Amount of Payment: (ln.KindFMU) $ $17,500
(month, day, year) (Round to whole dollars.)
Payment Type: 0 Monetary Donation or ❑ In -Kind Goods or Services (Provide description below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative
❑ Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
on October 5, 2019 and Turkey Give Away to be held in November 2019
5. Amendment Description and/or Comments
fi. Verification
Stage Sponsor for Jazz Festival
I certify, under penalty of pejury under the laws of the State of Califomia, that to the best of my knowledge, the information contained
herein is true and complete.
Lle
Executed on ori 8y
FPPC Form 803 (January/2018)
FPPC Toil -Free Helpline: 866/ASK-FPPC (866/275-3772)