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803 Geoff Kors 2022-02-17 Robin Hensley & Peter SalvariBehested Payment Report 1. Elected Officer or CPUC Mem Kors, Geoffrey City of Palm Springs 3200 E. Tahquitz Canyon Way (Name and A Public (Last name, First name) Number I E-mail (Optionao 760-323-8299 i�ECEiYED Date Stamp- ZO 2 FEB 17 PF? : FC% LIB 111._ �.•f i I 1�„ ❑ Amendment (see Parts) Behested Payment Report For Official Use Date of Original Filing: (month, day, year) 2. Payor Information (For additional payors, include an attachment with the names and addresses.) go 3. Payee Information (For additional payees, include an attachment with the names and addresses.) Planned Parenthood of the Pacific Southwest Name 1075 Camino del Rio South San Diego CA 92108 Address City State Zip Code 4. Payment Information (Complete all information.) Date of Payment: 3a r' Amount of Payment: (In-)QWFUa j $ (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 © Charitable Describe the legislative, governmental, charitable purpose, or event: Donation to PPPSW Anniversary Celbration 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 41��Z; By DATE S ECTED OFFICER MEMBER FPPC Form 803 (January/2018) FPPC Toll -Free Nelpline: 866/ASK-FPPC (866/275-3772)