803 Geoff Kors 2022-02-17 Arnold La Garcia and Susan MazzaBehested Payment Report A Public DocumR E Ca j V E D gehested Payment Report
1. Elected Officer or CPUC Member (cast name, First name) Date Stamp • . ,
Kors, Geoffrey 2922 FEB 17 3 •
Agency Name or 016dal Use Only
City of Palm Springs r ICE OF THE C( i'
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (See Parr 5)
Area Code/Phone Number E-mall (optionao Date of Original Filing:
760-323-8299 (month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
ZL%'U/// /% /'itrgi LZA Name j
►, 7 6,v, �1���
Address
City Istate P zip a
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Planned Parenthood of the Pack Southwest
1075 Camino del Rio South San Diego CA 92108
Address City state Zip Code
4. Payment Information (Complete all information.)
Date of Payment: �') ') )-) Amount of Payment: (In Klnd FM10 $ ___ 7S
(month, d y, year) (Round to whole dollars.)
Payment Type: ® Monetary Donation
Brief Description of In -Kind Payment:
or ❑ In -Kind Goods or Services (Provide deeortpton below.)
Purpose: (Check one and provide descnpimn below.) ❑ Legislative ❑ Governmental ® Charitable
Describe the legislative, governmental, charitable purpose, or event:
Donation to PPPSW Anniversary Celbration
Amendment Description and/or Comments
6. Verification
1 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 ____L_L� By
DATE %QNATURE OF CTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/27S-3772)