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HomeMy WebLinkAbout803 Geoffrey Kors 2022-01-13 Randy Clark & Tom Maddox. MDBehested Payment Report A Public Document R L Ww IV 1. Elected Officer or CPUC Member (cast Hama, First name) CITY U Fate gtavn� P Kors, Geoffrey JA 8 PM I ---- "--- City of Palm Springs 3200 E. Tahquitz Canyon Way Area Code/Phone Number IE-mail (optional) 760-323-8299 2. PayorInformation (For additional payors, include eaan PGf i L7 t^ ///rK r- �l�Y_ // �i ! r,_ In ! 'a d_.t_' ❑ Amendment (See Part 5) Behested Payment Report For Official Use Only Date of Original Filing: (month, day, year) with the names and addresses.) . `l� I 1 // - .. Addrem City State 74 Zip Cale 3. Payee Information (For additional payees, include an attachment with the names and addresses.) Planned Parenthood of the Pacific Southwest Name - _ _---- 1075 Camino del Rio South San Diego CA 92108 Addrew City state Zip Cade 4. Payment Information (Complete all information.) Date of Payment: a L Amount of Payment: (in -land FlvRr) $ / �), / 4(mon h, day, around whole liars.) Payment Type: © 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 — /#� / v �_ By DATt OR FPPC Form 803 (January/20181 FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)