803 Geoff Kors 2019-01-24 Ronald and Carol Fragen TrustBehested Payment Report A Public Document. Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name) ! Date Stamp • • '
Kors, Geoffrey • •
Agency Name 2a P 1'� 4 ' 21 For Official Use Only
Palm Springs City Council
Anpnry Straat Arldraccn
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (See Part 5)
Area Code/Phone Number E-mail (Optional)
Date of Original Filing:
(month, day, year)
7605370061 Geoff.kors@gmail.com
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Ronald and Carol Fragen Trust
Name
64893 Saragossa Drive Palm Springs CA 92264
Address City State Zip Code
3. Payee Information (Foradditional 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 all information.)
Date of Payment: 01/22/1029 Amount of Payment: (In-KindFMv) $ 25000
(month, day, year) (Round to whole dollars.)
Payment Type: p Monetary Donation or ❑ In -Kind Goods or Services (Provide desorption below.)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental
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
❑x Charitable
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 01 /24/2019 By
DATE
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)