803 Geoff Kors 2019-05-30 Harold MatznerBehested Pavment Report A Public Document aehested Payment Report
1. Elected Officer or CPUC Member (Last name. First name)
Date Sta7
Kors, Geoffr
3
'
For Cf c ai Use only
Agency Name
Palm Springs City Council
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. day, year)
Area Code/Phone Number
E-mail (optional)
7605370061
2. Payor Information (Foradditional payors, include an attachment with the names and addresses.)
Harold Metzner
181 S. Civic Dr. #1 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
Address City State Zip Code
4. Payment Information (Complete all information)
04/10/19 25,000
Date of Payment: Amount of Payment: (In-wneFMv) $
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (Provide descrlpbon below)
Brief Description of In -Kind Payment:
Purpose: (Check one andprowde description below) ❑ Legislative ❑ Governmental ❑X Charitable
Describe the legislative, governmental, charitable purpose, or event:
Donation to Stars Among Us Gala for Meals on Wheels Program
5. Amendment Description and/or Comments
Information has been repeatedly requested and accounting was finally provided on 05/22/19
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 05/30/2019 By
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)