HomeMy WebLinkAbout2023-12 Form 802-YMCA Hoedown at SundownDocuSign Envelope ID: 40A192 67-B557-4AB1-94E2-9EBFC7773078
Agency Kepon ot:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name Ct California 802
CITY OF PALM DESERT p Form
Division, Department, or Region (if applicable)
Designated Agency Contact (Name , Title)
ANTHONY J. MEJIA , CITY CLERK
Area Code/Phone Number
760-346-0611
E-mail
amejia@palmdesert .g ov
For Official Use Onl y
D Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing: _______ _
(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? 70.00 Yes ■ No □ Face Value of Each Ticket/Pass $ _______ _
Event Description : YMCA Hoedown at Sundown
Provide Title/ Explanation
__J__J __
Ticket(s)/Pass(es) provided by agency? Yes ■ No D If no : _________________ _
Was ticket distribution made at the behest Yes ■ No □
of agency official?
3. Recipients
Name of Source
If yes : HILEMAN , TODD
Official's Name (Last, First)
• Use Section A to id entify the agency's depa rtment or unit. • Use Section B to identify an individual. Use Sec tion C to iden t ify an outside organization .
Number
A. Name of Agency, Department or Unit of Tlcket(s)I Describe the public purpose made pursuant to the agency's policy
Passes
CITY MANAGER DEPARTMENT 1 PD Resolution No. 2019-70 Section 6-C-17
ECONOMIC DEVELOPMENT 4 PD Resolution No . 2019-70 Section 6-C-17
Number B. Name of Individual of Ticket(s)I Identify one of the following:
(Last, First) Passes I
Ceremonia l Role D Oth er D Income D
HARNIK , JAN 1 If checking ·c eremonial Role · or "Other" describe below:
PD Resolution No . 2019-70 Section 6-C-17
Ceremonial Role D Other D Income D
If checking "Ceremonial Role " or "Other" describe below:
Name of Outside Organization Number
C. of Ticket(s)I Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
I have read and understand FPPC Regulations 18944. 1 and 18942. I have verified that the distribution set forth above, is in accordance
with the ri ~.by:
ANTHONY J. MEJIA CITY CLERK 11/6/2023
Signatur Print Name ntle (month, day, year)
Comment:-------------------------------------------
Print Clear FPPC Form 802 (212016)
FPPC Toll-Free Helpline: 866IASK-FPPC (8661275-3772)