803 Geoff Kors 2019-11-04 Mike BraseBehested Payment Report A Public Document
1. Elected Officer or CPUC Member (Last name. First name) RE C
Kors, Geoff
Palm Springs City Council
3200 E. Tahquitz Canyon Way
(Name and title, if different)
CITY Of PALM SPRINGS
2019NOVO4 PM 4: 47
7FFICE F THE CITY CLERI:
❑ Amendment (see Part 5)
Behested Payment Report
For Official Use Only
Area Code/Phone Number E-mall (Optional) Date of Original Filing:
7605370061 (month, day, year)
Payor Information (For additional payors, include an attachment with the names and addresses.)
Mike Brase
Address City State Zlp Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Equality California
Name
3701 Wilshire Blvd #725 Los Angeles CA 90010
Address City State Zip Code
4. Payment Information (Complete all information.)
Date of Payment: 10/21/19 Amount of Payment: (in-KindFMV) $ 5,000
(month, day, year) (Round to whole dollars.)
Payment Type: p Monetary Donation or ❑ In -Kind Goods or Services (Provide description below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below) [I Legislative ❑Governmental ❑x Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2019 Equality Awards
5. Amendment Description and/or Comments
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.
G
Executed on 4IN11/19 By
DATE SIGNATURE OF ELECTED OFFICER OR CP C MEMBER
FPPC Form 903 (January/2018)
FPPC Toll -Free lielpline: 866/ASK-FPPC (866/27S-3772)