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HomeMy WebLinkAbout803 Geoffrey Kors 2022-01-13 Judy feldmomBehested Payment Report 1. Elected Officer or CPUC Men Kors, Geoffrey Flgency Name City of Palm Springs 3200 E. Tahquitz Canyon Way A Public DocumerdE��i ED R1Nt;S sehesteaPayment Report (Last name, First name) (Name and title, if different) Area Code/Phone Number I E-mail (optional) 760-323-8299 CIA Z v' Date St , e • , :a 10 For Offiaal Use Only ❑ Amendment (See Part 5) Date of Original Filing: (month, day, year) 2. Payor Information (For additional payors, include an attachment with the names and addresses.) J LA � L', P, d Al 6r� run t Sfi I)3a3 56;1 Aooress City ' State 2ip Cofie 3. Payee Information (For additional payees, include an attachment with the names and addresses.) Planned Parenthood of the Pacific Southwest rvame 1075 Camino del Rio South San Diego CA 92108 Address City State Zip Code 4. Payment Information (Complete all information.) Date of Payment: 12114za 1 Amount of Payment: (in -Kind FMV) $ (month,lday, year) (o ndto whole dollars.) Payment Type: x❑ 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 © Charitable Describe the legislative, governmental, charitable purpose, or event: Donation to PPPSW Anniversary Celbration 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 lk�By DATE FPPC Form 803 (January/2018) FPPC Toll -free Helpline: 866/ASK-FPPC (866/275-3772)