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Behested Payment Report A Public Document
1, Elected Officer or CPUC Member (Last name, First name) R E 0**14tiQ•
Kors, Geoffrey CITY OF P PLH SPRING
Agency Name 202 JUL 15 PH 6: 5 1
City of Palm Springs
ency street Address IFFl E OF THE CITY CLL
Ag
3200 E. Tahquitz Canyon Way
and title, if different)
Area CodelPhone Number I E-mail (Optional)
(760) 323-8299
2. Pavor I
Behested Payment Report
For Official Use Onty
Amendment (See Part 5)
Date of Original Filing: oR
(F-1517th, day, year)
(For additional payors, include an attachment with the names and addresses.)
toult &vw1P Ijneri t I1 GIPIC t-1
4 tv 14W-1 111
in
W10 --r
Address City state Lip i.:ooe
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
Name
450 S Sunrise Way Palm Springs CA 92264
Address City State Zip Code
4. Payment Information (Complete all information.) r
Date of Payment: Amount of Payment: (In-tand FW $ / v
(mbrith, day, year) (Round to whole dollars)
Payment Type: Monetary Donation or ❑ In -Kind Goods or Services (provide description below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative ❑ Govemmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
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.
Executed on )-)
1 DATE
By Z, � 7" � �, a5:� "
SIG RE Of ELECTED OFFICER OR rPllX MEMBER
FPPC,Form B03 (lanuary/2018)
FPPC Toll -Free "elpline: 866JASK-FPPC t866/275-37721
Behested Payment Report
4. Elected Officer or CPUC Men
Kors, Geoffrey
City of Palm Springs
3200 E. Tahquitz Canyon Way
A Public Document
(Las$ name, First name)
(Name and title, if ddferent)
R E 4 E I V ale Stamp
CIT �' OF PALM SPRINGS
2021 JUL 15 PH b*. 51
HE CITY CLE
❑ Amendment (See Part 5)
Behested Payment Report
For Officaat Use Only
Area Code/Phone Number E-mail fOphonal) Date of Original Filing:
(mant , de , yeer)
(760) 323-8299
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Name - 1
Addraw City State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
Name
450 S Sunrise Way Palm Springs CA 92264
Address City State Zip Code
4. Payment Information (Compieteaiiintom+atfon)
Date of Payment: kI Amount of Payment: (iri-tandFMI/) $ za, 00
( , day,Year) 6(Ratind to whale dailars )
Payment Type: }.Monetary Donation or ❑ In -Kind Goods or Services (Provide description below
Brief Description of In -Kind Payment:
Purpose: (Check one and provldedescdptionbelowJ ❑ Legislative ❑ Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2021 Halloween Gala to Support the Boys & Girls Club of Palm Springs and our Youth
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.
Executed on r By
DATE WOW VJV(F- Of ELECTED OFFICER OR CtsUC MEMBER
FPPC Form 803 (January/2018}
tPPCTOq-Free Hetpilne: 866/ASK-WE (866/27537721