803 Geoffrey Kors 2022-01-13 Fred NobleBehested Payment Report A Public Document RECEIVED Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name) ' `'gate S1"' nP • • ,
Kors, Geoffrey 4 p n •
Agency Name 022 JAN 18 Phi For Official Use Only
City of Palm Springs �I 1- # � 0 W- -1_.' r,Ty LEF
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (see Part 5)
Area Code/Phone Number E-mail (Optional) Date of Original Filing:
(month, day, year)
(760) 323-8299
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
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.)
Date of Payment: Amount of Payment: (in -Kind FMv) $ ld �Jc2 0
f(montil, da , y ar) (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 N 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 l�/ °Z By
DATE SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)