803 Geoff Kors 2019-02-25 John F. Grundhofer Charitable FoundationBehested Payment Report A Public Document
1. Elected Officer or CPUC Member (Last name, First name) Date Stamp
Kors, Geoffrey 2019 FED 25 PH 4: 47
City of Palm Springs
3200 E. Tahquitz Canyon Way
(Name and title, if different)
Number
7605370061 1 Geoff.kors@gmail.com
❑ Amendment (see Part 5)
Behested Payment Report
For Official Use Only
Date of Original Filing:
(month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
John F Grundhofer Charitable Foundation
221 E 13th St. Souix Falls SD 57104
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
Address City state Zip Code
4. Payment Information (Complete aninroriation.)
Date of Payment: 1/22/19 Amount of Payment: (In-KindFMV) $ 10000.00
(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:
Pu rpose: (Check one and provide description below.) ❑Legislative ❑Governmental ❑x Charitable
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.
Executed on 02/22/2019 By
DATE
FPPC Form 803(January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)