803 Geoffrey Kors 2022-01-13 Joe FitzpatrickBehested Payment Report A Public DocumentR E C E. [ V ED
1. Elected Officer or CPUC Member (Last name, First name)
Kors, Geoffrey
City of Palm Springs
3200 E. Tahquitz Canyon Way
'designated Contact Person (Name and We, if
Area Code/Phone Number I E-mail (optional)
(760)323-8299
J H 18 FM i `
❑ 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.)
�1-nto `' I Ir � 16 6
Address
City
C 11�_ �; 6' P1-1
State Zip
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Boys & Girls Club of Palm Springs
450 S Sunrise Way
Address
Palm Springs CA 92262
City State Zip Code
4. Payment Information (Complete all information.)
Date of Payment: Amount of Payment: (in -Kind FMv) $
(m nth, y, year) (17ourrd fo whole dollars.)
Payment Type: Omonetary 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.
Z22Executed on z By
DATE
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)