803 Geoffrey Kors 2022-01-13 Harlod MatznerBehested Payment Report A Public Document_ . � �. i V E D
1. Elected Officer or CPUC Member (cast name, First name)
Kors, Geoffrey
City of Palm Springs
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if
Area Code/Phone Number E-mail (optional)
(760) 323-8299
Date Stamp
JAN 18 Pyl i *'
TV
❑ Amendment (see Part 5)
Behested Payment Report
For Official Use Only
Date of Original Filing:
(month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
rvame r -
I �r s lam,✓r � �� � PALM s�r���s � �+ ���G�
Naoress 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 all information.)
Date of Payment: IVIIM Amount of Payment: (in -Kind FMV) $ Z d OO
(m nth, 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 LK 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
S. 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 ZbwBy
DATE
OF
OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)