803 Geoff Kors 2019-01-24 Walmart Inc.Behested Payment Report A Public Document; Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name) DW6 stamp PFor
• -7Only
GeoffreyAgency oName19 �� N 'jZ 4 P �' 12'Official U
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:
7605370061 Geoff.kors@gmail.com (month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Walmart Inc.
Name
702 SW 8th St. Bentonville AR 72716
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: 01/02/1029 Amount of Payment: (ln-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
0 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
OR CPllC MEMBER
FPPC Form 803 (January/2018)
FPPC Tall -Free Helpline: 866/ASK-FPPC (866/275-3772)