803 Geoff Kors 2019-01-24 The Grace Helen Spearman FoundationBehested Payment Report A Public Documefit . i `r` Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name) Date Stamp • • ,
Kors, Geoffrey N 24 PIN 12: 39
Agency Name For Official Use Only
Palm Springs City Council -
Agency Street Address
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.)
The Grace Helen Spearman Foundation
Name
4283 Arcada Street 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 all information.)
Date of Payment: 01/22/1029 Amount of Payment: (in-KindFMV) $ 5000
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x 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
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
DATE
By SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)