HomeMy WebLinkAbout803 Geoffrey Kors 2022-05-05 Tour de PSBehested Payment Report
A Public Document
Type or Print In Ink.
1.Elected Officer or CPUC Member (Last name, First name)ELECTED OFFICER OR CPUC MEMBER: rGENCY NAME:
Amendment of FIiing D Check box if an Amendment
'ontfi, Day, Lr)
# Confirmation Number
Dff1tl!�ncy)
MAY 5 2022
�GENCY STREET ADDRESS:
CALIFORNIA 803 FORM
Kors, Geoffrey City of Palm Springs 3200 E Tahquitz Canyon Way, Palm Springs, CA 92262 DESIGNATED CONTACT PERSON (NAME AND TITLE):rREA CODE/PHONE NUMBER:
760-323-8299
f•MAIL:
geoff.kors@palmpringsca.gov
2.Payor Information (For additional payors, include an attachment with the names, addresses, and proceeding information)NAME: p _5 r�¥S:
D Donor Advised Fund (DAF) (see instructions) IDAF NAlJfE:
RIEF DESCRIPTION OF PROCEEDINGS: D Payor Is a named party or the subject of a proceeding before my agency.
3.Payee Information (For additional payees, include an attachment with the names, addresses and relationship Information) NAME: ADDRESS:
Boys & Girls Club of Palm Springs 450 S. Sunrise Way
CITY:
Palm Springs
STATE: ZIP CODE:
CA 92262 For a nonprofit organization payee, provide a brief description of any relationship to the official, official's Immediate family member or staff member in the role of founder, salaried employee, decision-making capacity (l>oard member or executive officer) or position on an honorary or advisory board. NAME AND TITLE: 'ROLE WITH THE NONPROFIT ORGANIZATION: IBRIEF DESCRIPTION:
Geoffrey Kors, President Board of Directors President Board of Directors Self
4.Payment Information (Complete all information. For estimated payment information check the box below.)DATE AMOUNT PAYMENT TYPE BRIEF DESCRIPTION OF IN-KIND PAYMENT PURPOSE DESCRIBE THl LEGISLATIVEE GOVERNMENTAL, (MONTH/DAY/YEAR) CHARIT BLE PURPOS , OR EVENT: 1�l1J-�MONETARY DONATION B LEGISLATIVE
),ffV GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES @ CHARITABLE
( . 0 MONETARY DONATION 0 LEGISLATIVE 8 GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES CHARITABLE REASON FOR ESTIMATE: □ 1he !DATEJAMouNT) Is an estimate and reflects my best efforts at obtaining the accurate Information.
5.
6.Verification
Executed on < ':s 5Ls9 c:::::::
'Provide date of original filing_ or confirmation number in Part 1.
By 1Pd'!7�� -==
Sponsorship of 2022 Fundraising Event
FPPC Form 803 (February/2022) advice@fppc.ca.gov