803 Geoffrey Kors 2021-10-18 Hot Purple EnergyBehested Payment Report A Public Doc
1. Elected Officer or CPUC Member (Last name, First name)
Kors, Geoffrey
ECEI'-,! ED
Date Stamp
OCT 18 PM 4: 0
City of Palm Springs Or F10E OF THE CITY CLE1
%gency Street Address
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (See Part 5)
Behested Payment Report
For Official Use Only
Area Code/Phone Number E-mail (optional)
: Filing
Date of Original(month, day, year)
(760) 323-8299
2. Payor Information,r adddditiioonnallpparyors, include an attachment with the names and addresses.)
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Nam
$l a 61,r
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
Name
450 S Sunrise Way Palm Springs CA
92264
Address city State
Zip Code
4. Payment Information (Complete aft information.)
2 �j GUU
Date of Payment: Amount of Payment: (In -Kind FMv) $ !
(rrfbAth, 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 ❑ Governmental 9 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
Pt6ewrl or, �t.. 6r aChJ�' 0, a-oa I
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 t / By
OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)