803 Geoff Kors 2019-05-30 Grace Helen Spearman FoundationBehested Payment Report
1. Elected Officer or CPUC Men
Kors, Geoffrey
Agency Name
City of Palm Springs
Agency Street Address
3200 E. Tahquitz Canyon Way
A Public Document
(Last name, First name)
and title. it different)
Area Code/Phone Number E-mail (Optionao
7605370061 1 Geoff.kors@gmail.com
2015 ;
P114-v�
❑ Amendment(see Part 5)
Behested Payment Report
For Official Use Only
Date of Original Filing:
(month, day, year)
(For additional payons, include an attachment with the names and addresses.)
Grace Helen Spearman Foundation
4283 Arcade St. 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 auintormahon.)
Date of Payment: 4/16/19 Amount of Payment: (in-xlndFMv) $ 5000.00
(month, day, year) (Round to whole dollars.)
Payment Type: 0 Monetary Donation or ❑ In -Kind Goods or Services(pmvide descdphon below)
Brief Description of In -Kind Payment:
PurpOSO: (Check one and provide descdphon below.) ❑ Legislative ❑ Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Donation for Stars Among Us Gala Benef7tting Meals on Wheels Program
5. Amendment Description and/or Comments
Information requested numerous times from organization. Received on 5/22/19
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 SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 903(January/2018)
FPPCToll-Free Helpline: 866/ASK-FPPC (866/275.3772)