803 Geoffrey Kors 2022-01-13 Grit DepartmentBehested Payment Report A Public Document
1. Elected Officer or CPUC Member (cast name, First name)
Kors, Geoffrey
City of Palm Springs
3200 E. Tahquitz Canyon Way
(Name and title, if different)
2022 JAN IS Prli
❑ Amendment (See Part 5)
Behested Payment Report
Official Use Only
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 92262
Address city State Zip Code
4. Payment Information (complete all information.)
Date of Payment:6__�Amount of Payment: (in -Kind Fmv) $
SaGG
(mo th, dap, year) (Round td 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 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of Annual Event Supporting 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
DATE
By SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)