803 Geoff Kors 2019-05-30 Jack & Patti GrundhoferBehested Payment Report A Public Document
1. Elected Officer or CPUC Member (Last name, First name) tale stamp
Kors, Geoff rt)
Palm Springs City Council
3200 E. Tahquitz Canyon Way
7605370061
(Name and title,
(Option))
❑ Amendment (See Part 5)
6ehested Payment Report
For Official Use Only
Date of Original Filing:
(month, day, year)
(Far additional payors, include an attachment with the names and addresses.)
Jack & Patti Grundhofer
46-180 Onyx Court
Indian Wells
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Mizell Senior Center
Name
CA 92210
state Zip Code
480 S. Sunrise Way Palm Springs CA 92262
Address City state zip Code
4. Payment Information (Complete all mtormaton.)
Date of Payment: 07/12/18 Amount of Payment: (in-IcndFMv) $ 20,000
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services(Pmwde deswrpdon below)
Brief Description of In -Kind Payment:
Pu rpose: (Crack one and provide descdpdon below) [I Legislative ❑Governmental ZCharitable
Describe the legislative, governmental, charitable purpose, or event:
Donation to Stars Among Us Gala for Meals on Wheels Program
S. 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
DATE SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -free Helpline: 866/ASK-FPPC (866/275-3772)