803 Geoff Kors 2019-02-25 Grace Helen Spearman FoundationBehested Payment Report
1. Elected Officer or CPUC Men
Kars, Geoffrey
City of Palm Springs
3200 E. Tahquitz Canyon Way
A Public Document
(Last name, First name)
Area Code/Phone Number E-mail (Optional)
7605370061 Geoff.kors@gmail.com
Behested Payment Report
Date Stamp • •• '
A
2 53 Ll : 48 1 For Official Use Only
❑ Amendment (see Pert 5)
Date of Original Filing:
(month, day,
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
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
480 S. Sunrise Way
Palm Springs
CA 92262
4. Payment Information (Complete allinrormation.)
Date of Payment: 1/22/19 Amount of Payment: pn-KindFMV) $ 5000.00
(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 andprovide description below) [I Legislative ❑Governmental 0Charitable
Describe the legislative, governmental, charitable purpose, or event:
Donation for Stars Among Us Gala Benefitting 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.
02/22/2019
Executed on By
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)