803 Geoff Kors 2021-12-2 William SchefflerA Public
1. Elected Officer or CPUC Member (cast name, First name)
Kors, Geoffrey
City of Palm Springs
3200 E. Tahquitz Canyon Way
(Name and title, ifditf°erent)
Area Code/Phone Number E-mail (options!)
(760) 323-8299
rvvM�4 ' E i &f I,. D
I T Y U:
C —6 011: 22
i c T1_zr r 11 � I ci_T
❑ Amendment (See Pan 5)
Behested Payment Report
For Ofridal Use Only
Date of Original Filing:
(month, day, yeah
2. Payor information (For additional payors, include an attachment with the names and addresses.)
Address
City State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
Name
450 S Sunrise Way Palm Springs CA
Address 92264
Cdy State Zip Code
4. Payment Information (complete aft inrormation.)
Date of Payment: ----2&21 Amount of Payment: (to -Kind FmA q $ I� (month, day, year)
Payment Type: (ROU d wrote deters.)
❑ Monetary Donation or In -Kind Goods or Services (Provide desc;ption below)
Brief Description of In -Kind Payment: bS
Purpose: (Check one and provide description below)
El Legislative
Behested Payment Report
❑ Governmental
Describe the legislative, governmental, charitable purpose, or event-
0 Charitable
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
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 By
DATE
FPPC Form 803 (January/20181
FPPCIall-Free Hetptine: 866/ASK-FPPC (866/275-37721
Behested Payment Report A Public Document R E C E :: _= D
1. Elected Officer or CPUC Member (Last name, First name) ` ` Dale Stamp `
Kors, Geoffrey
A w........ U....... J. l DEC - 6
City of Palm Springs
ygency ozreez Aaaress
3200 E. Tahquitz Canyon Way
(Name and title, if different)
Area Code/Phone Number I E-mail (optional)
(760) 323-8299
�C- `F THr JI i Y Cf-F
❑ Amendment (See Part 5)
Reheated Payment Report
For Official Use Only
Date of Original Filing:
(month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
name
450 S Sunrise Way Palm Springs CA 92264
Address city state Zip Code
4. Payment Information (complete all informauon.)
Date of Payment: hj3lll� f Amount of Payment: (In -Rind FUV) $
(mo th, day, ear) 9 (Rou9to whole dollars.)
Payment Type: Monetary Donation or ❑ In -Kind Goods or Services (Provide descrlption below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
5. Amendment Description and/or Comments
O. venTication
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 By
DATE
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Behested Payment Report
A Public Docu
9. Elected Officer or CPUC Member Gast name, First name)
Kors, Geoffrey
Agency Name
City of Palm Springs
3200 E. Tahquitz Canyon Way
(Name and title, if
Area Code/Phone Number E-mail (optional)
(760)323-8299
farmPRIN
DEC -6 AN 11: 2
OF I HF Ci - y CI
❑ Amendment (See Part 5)
Behested Payment Report
For official use Only
Date of Original Filing:
(month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
✓ a _
!�!AsId (- Oe
city r Slate p code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
Name
450 S Sunrise Way Palm Springs CA 92264
Andress city state
Zip Code
4. Payment Information (complete an information.)
Date of Payment: 'f I ( Amount of Payment: (ln4GndFMV) $ J� S0�[% tr U ; oe day, fi
ay, W. (Round to whole dollars.)
Payment Type: KMonetary Donation or
❑ In -Kind Goods or Services (Provide desaipNon below.)
Brief Description of In -Kind Payment:
Purpose: (check one and provide deswPdon below.) ❑ Legislative ❑ Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
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 al-hBy
DA
FPPC Form 803 (January/2018)
FPPC Toll -Free HeVptine: 866/ASK-FPPC (866f275-3772)
Behested Payment Report A Public Document
1. Elected Officer or CPUC Member (cast name, First name) C I T Y C Dati2
Kors, Geoffrey
City of Palm Springs
3200 E. Tahquitz Canyon Way
n (Name and title, if
Area Code/Phone Number E-mail (optional)
(760) 323-8299
6 DEC - 6 AFC I 1
-ACE OF THE
❑ Amendment (See Part 5)
Behested Payment Report
For Official Use Only
Date of Original Filing:
(month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Name
State
J. rayesa mrurntairon (For additional payees, include an attachment with the names and addresses.)
Boys & Gins Club of Palm Springs
450 S Sunrise Way Palm Springs CA 92264
Address CPty state Zip Code
raymeni myormation (Complete all information.)
Date of Payment: Amount of Payment: (In-fandFMv) $ U�
month, d y, year) (Round to whole dollars.)
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 N Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
S. 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 1 By
A St TU 4'co aft CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Behested Payment Report A Public Document R E C; ; E D d Payment Report
1. Elected Officer or CPUC Member (Last name, First name) 'Da,`Stamp - M
•
Kors, Geoffrey 014
Agency Name �� t�t3lForr Official Use Only
City of Palm Springs F,�F C;; I i LL
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and titre, if different)
❑ Amendment (See Part 5)
Area CodelPhone Number E-mail (Optional) Date of Original Filing:
(760) 323-8299 (month, day, year)
2. Payor formation (For ad5Payors,lanai include an attachment with the names and addresses.)
Name
Address CIty r State Zip od
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
Name
450 S Sunrise Way Palm Springs CA 92264
Address City state Zip Code
4. Payment Information (Complete all information.)
Date of Payment: Amount of Payment: (in -Kind $ D
month, day, year) ?Round o whole dollars.)
Payment Type: J91 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 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
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 /oL ;, k By
DATE SIGN&WMELECTIED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 856/ASK-FPPC (866/275-3772)
Behested Payment Report A Public Docu _ to-p BehesiedPayment Report
1. Elected Officer or CPUC Member (Lastname, First name) Ci-Date stamp e • '
Kors, Geoffrey �+ L gW. •
Agency Name t, U e For Offiaal Use Onty
City of Palm Springs
clrc r.�
3200 E. Tahquitz Canyon Way
and title, if different)
❑ Amendment (see Part 5)
Area Code/Phone Number E-mail (optional) Date of original Filing:
(760) 323-8299 (month, day, year)
2. PayorInformationn�(For additional payors, include an attachment with the names and addresses.)
11
ao A•
City
ytrt: Information (For additional payees, include an attachment with the names and addresses.)
_A 911; a7
sate Zip Code
Boys & Girls Club of Palm Springs
Name
450 S Sunrise Way Palm Springs CA 92264
Address City State Zip Code
4. Payment Information (c mplete all informs&on.)
Date of Payment: Amount of Payment: (lndGnd FMV) $ d/
(MO , day, ear) (Round 16 whole d rs.)
Payment Type: ❑ MonetaryDonation In -Kind Goods or Services
or ❑ I(Provide description below.)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
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 By
DA
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)