803 Geoff Kors 2018-10-29-2Behested Payment Report
A Public Document
Behested Payment Report
1. Elected Officer or CPUC Member (last name, First name)
Date Stamp
• '
Kors, Geoffrey
CT 29 Ali 7: 54
For official Use Only
Agency Name 2919
Palm Springs City Council
• • _- '_
Agency Street Address - -
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (See Part a)
Date of original Filing:
(month, day, year)
Area Code/Phone Number
E-mail (Optional)
7605370061
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
V. Manuel Perez for Supervisor 2018
84668 Sunrise Ave. Coachella CA 92236
Address City state Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Mizell Senior Center
480 S. Sunrise Way Palm Springs CA 92262
Address City State Zip Code
4. Payment Information (Complete all information.)
Date of Payment: 10/02/18 Amount of Payment: pn-wndFMv) $ 25,000
(month, day, year) (Round to whole dollars.)
Payment Type: ❑ Monetary Donation or ❑ In -Kind Goods or Services (Provide descdption below)
Brief Description of In -Kind Payment:
Purpose: (Checkone and provide description below) [I Legislative El Governmental ❑x Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of Gala in support of Meals on Wheels Program
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 10/22/2018 By
DATE
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpiine: 866/ASK-FPPC (866/275-3772)