803 Geoff Kors 2019-01-24 Jacky AutryBehested Payment Report
1. Elected Officer or CPUC Men
Kors, Geoffrey
Palm Springs City Council
3200 E. Tahquitz Canyon Way
A Public Document
(Last name, First name)
Date Stamp
❑ Amendment (See Part 5)
Behested Payment Report
For Official Use Only
Area Code/Phone Number E-mail (Optional) Date of Original Filing:
7605370061 Geoff.kors@gmail.com (month, day, year)
Payor Information (For additional payors, include an attachment with the names and addresses.)
Jacky Autry
328 West Mountain View
Palm Springs
CA 92262
Address City State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Mizell Senior Center
Name
480 S. Sunrise Way Palm Springs CA 92262
Address City State Zip Code
4. Payment Information (complete a0lnrormation.)
Date of Payment: 01/22/1029 Amount of Payment: (in-KindFMV) $ 10000
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services(Pmvlde description below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide descdp6'on below.) [I Legislative [I Governmental 9Charitable
Describe the legislative, governmental, charitable purpose, or event:
Stars Among Us Event Sponsorship for 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.
01 /24/2019
Executed on ____ By
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/2753772)