803 Geoff Kors 2019-09-10 Grace Helen Spearman FoundationBehested Payment Report A Public Docurr
1. Elected Officer or CPUC Member (Last name, First name) CIT
Kors, Geoff
Palm Springs City Council
3200 E. Tahquitz Canyon Way
(Name and title, if different)
Area Code/Phone Number I E-mail (optional)
7605370061
EIV
SEP 10 AM 10* 4
E OF THE CITY CL
❑ Amendment (See Part 5)
Behested Payment Report
For Official Use Only
Date of Original Filing:
(month, day. year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Grace Helen Spearman Charitable Foundation
4283 Arcada Steel Palm Springs CA 92262
Address City State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
450 S. Sunrise Way
Address
Palm Springs
CA 92262
4. Payment Information (Complete all information)
Date of Payment: 07/01/19 Amount of Payment: (In4gruirmy) $ 7,500
(month. day. year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (Provide description below)
Brief Description of In -Kind Payment:
Purpose: (Check one andprowde description below.) ❑Legislative ❑Governmental
Describe the legislative, governmental, charitable purpose, or event:
General Operating Grant
5. Amendment Description and/or Comments
Information provided to me on August 28, 2019
6. Verification
❑x Charitable
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 09/08/19_ By
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)