803 Geoff Kors 2019-05-30 Jack & Patti Grundhofer RevisedBehested Payment Report A Public Document
1. Elected Officer or CPUC Member (Last name, First name)
Kors, Geoffrey
Palm Springs City Council
3200 E. Tahquitz Canyon Way
Area COdeJPI
7605370061
(Name and title, if different)
(Optional)
Date Stamp
9 ii;'i 30 Fii 4:
Behested Payment Report
For Official Use Only
❑X Amendment (See Part 5)
Date of Original Filing: 09/20/18
(month, deg year)
2. Payor Information (For additional payors, include an attachment with the names and addresses,)
Jack & Patti Grundhofer
46-180 Onyx Court Indian Wells CA 92210
Address City stale 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.)
Date of Payment: 09/07/18 Amount of Payment: nn-wndFMv) $ 20,000
(month, day, year) (Round to whole dollars)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services(Pmvide dasalptiun below)
Brief Description of In -Kind Payment:
Purpose: (Check one and pmNde descdpdon 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
Amending to the correct amount and including the address provided by the organization. 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)