803 Geoffrey Kors 2022-01-13 Kevin CorcoranBehested Payment Report A Public Document E! V E D
1. Elected Officer or CPUC Member (Last name, First name) f k Date Stamp
Kors, Geoffrey , a 3
City of Palm Springs
3200 E. Tahquitz Canyon Way
Person (Name
Area Code/Phone Number I E-mail (Optional)
(760) 323-8299
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-i�ICUE i 3I-It: t.i(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.)
-b. Bo S S 3__7 VO41-) SY'"",
Address City StM 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 92262
Address City State Zip Code
4. Payment Information (Complete all information.)
Date of Payment: LAmount of Payment: (In -rand FMv) $
n , day, year) (Round to whole dollars.)
Payment Type: gmonetary 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 By
DATE NATO D OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)