803 Geoff Kors 2018-12-18 Tenant HealthBehested Payment Report
A Public Document BenestedPayment Report
1. Elected Officer or CPUC Member (Last name, First name)
Date Stamp-
Kors, Geoffrey
1@ DEC 18 PH 4•777
Agency Name
Palm Springs City Council
`F""" , _
Agency Street Address
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, ifdifferent)
❑ Amendment (see Part 5)
Date of Original Filing:
Area Code/Phone Number
E-mail (Optional)
7605370061
(month, day, year)
1. Nayor Information (For additional payors, include an attachment with the names and addresses.)
Tenant Health
P.O. Box 130300 Dallas TX 75313
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 92264
Address City State Zip Code
4. Payment Information (Complete an information.)
Date of Payment: 11/09/2018 Amount of Payment: (In-KindFMv) $ 15000.00
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑In -Kind Goods or Services (Provide descripbonbelow.)
Brief Description of In -Kind Payment
Purpose: (Check one andprovide description below.) ❑Legislative [I Governmental ❑x Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of Stars Among Us Gala supporting Meals on Wheels Program
5. Amendment Description and/or Comments
6. Verification
I certify, under penalty of penury 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 12/18/18 By
DATE
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)