803 Geoff Kors 2019-02-25 Wells Fargo BankBehested Payment Report
A Public Document
Behested Payment Report
1. Elected Officer or CPUC Member (last name, First name)
Date Stamp
• • '
Kors, Geoffrey
`i:� y- 47
For Official Use Only
Agency Name �� ,I _-•%
City of Palm Springs
Agency Street Address
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (See Part 5)
Date of original Filing:
(month, defy, year)
Area Code/Phone Number
E-mail (Optional)
7605370061
Geoff.kors@gmail.com
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Wells Fargo Bank
550 S 4th St Minneapolis MN 55415
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 allinrormation.)
Date of Payment: 2/11/19 Amount of Payment: (In-xindFnnv) $ 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 and provide description below) ❑Legislative El 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 Toil -Free Helpline: 866/ASK-FPPC (866/275-3772)