803 Geoff Kors 2019-05-30 Lauri & Charles KibbyBehested Payment Report
1. Elected Officer or CPUC Men
Kors, Geoff r r
Palm Springs City Council
3200 E. Tahquitz Canyon Way
A Public Document .
(Last name, First name) I Date Stamp
`It 30 P14 4* 43
❑ Amendment (See Part 5)
Behested Payment Report
Use Only
Area Code/Phone Number E-mail (Optional) Date of Original Filing:
(month, tlay, year)
7605370061
Payor Information (For additional payors, include an attachment with the names and addresses.)
Lauri & Charles Kibby
1717 E. Vista Chino #A7-613 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 allinformation.)
Date of Payment: 04/10/19 Amount of Payment: pn-KindFMV) $ 10,000
(month, day, year) (Round to whole dollars.)
Payment Type: g Monetary Donation or ❑ In -Kind Goods or Services (Provide description below)
Brief Description of In -Kind Payment:
Purpose: (Check one and pmwde descdpbon below) [I Legislative ❑Governmental 0Charitable
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)