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Behested Payment Report A Public Document 0,,.% nested Payment Report <br /> 1. Elected Officer or CPUC Member(Last name,First name) t • ' <br /> Tdq I L6�Y WILL) ArY1 e <br /> Agency Name JUL 1 Z For official use only <br /> N1I'AYoR s QF1=(cC-_ C( --y OP PIVERSID& City or Rive side <br /> Agency Street Address City Clerk's ffice <br /> 3C1Q Q h OI N 'q2_1,22_ <br /> Designated Contact Person(Name and title,if different) Amendment(See Part 5) <br /> Area Code/Phone Number I E-mail(Optional) Date of Original Filing: <br /> q5'r S2_6 5�` (month,day,year) <br /> 2. Payor Information (For additional payors,include an attachment with the names and addresses.) <br /> p p rV K p f= Ø to 1 c (a c c R P . OF P m E R t c P Fu V fv,A iq T a rV <br /> Name <br /> 1.25 bVPCfVT P12W (�/) -J2 (- c r-3o , P1?Qvl1)l✓tvcc RHoyE� s5(-Ptvb 02q©-3 <br /> Address City State Zip Code <br /> 3. Payee Information (For additional payees,include an attachment with the names and addresses.) <br /> P(vE12sIDE PR7S coyr cIL <br /> Name <br /> _P�Q. BaX l b 62- PkV(E� R 5 1 DI~- CA 6125t2 e <br /> Address City State Zip Code <br /> 4. Payment Information (Complete all information.) <br /> Date of Payment: 0 V O-9'213 Amount of Payment: (In-Kind FMV) $ 101' r C C) <br /> (month,day,year) (Round to whole dollars.) <br /> Payment Type: [(Monetary Donation or ❑ In-Kind Goods or Services(Provide description below) <br /> Brief Description of In-Kind Payment: <br /> Purpose:(Check one and provide description below.) ❑Legislative ❑Governmental ®Charitable <br /> Describe the legislative, governmental,charitable purpose,or event: <br /> TNc ILW6 tV(6HT OF Af-7s 8� IrVN0VA-rlQfV <br /> 5. Amendment Description or Comments <br /> THE yQ.N(5 IV(CHt' ®r h12-TS 8 11'VtYGV1+-TI01t' t.s (a Ct=L);T8Rr4-(t0rV 9 7'11�ESe=rvTr=�70w <br /> OF RIVE./2slC'E. `A t3Es7- A(U(sz(c V, -50E/vT( P(c 'iAt-1-w7- -rc TIYE Comm(WI-T/ <br /> 6.Verification <br /> I certify, under penalty of perjury under the laws of the State of California,that to the best of my knowledge,the information contained <br /> herein is true and complete. <br /> Executed on O /15/2 0/3 By <br /> DATE SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER <br /> FPPC Form 803(December/09) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772) <br />