803 Geoffrey Kors 2022-02-17 Mark Hamlton and Juan FranciscoBehested Payment Report A Pubjip-D is ` iiiln!
1. Elected Officer or CPUC Member (Last name, First name) Date Stamp
Kors, Geoffrey 2022 FE ' {7 N 3: 2 2
City of Palm Springs
3200 E. Tahquitz Canyon Way
different)
Area Code/Phone Number +E-mail (Optionaq
760-323-8299 I
LI FiCE OF TH'EICI T Y CL
❑ Amendment (see Part 5)
Behested Payment Report
For Of idal Use
Date of Original Filing:
(month, day, year)
Payor Information (For additional payors, include an
attachment with the names and addresses.)
147
Name' r— 1
------ cRY I State Tip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Planned Parenthood of the Pacific Southwest
1075 Camino del Rio South San Diego CA 92108
Address MY State ap Code
4. Payment Information (complete all information.)
Date of Payment: Amount of Payment: (In -Kind F&M $ Si G1 i1
(Mbrith, da , 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 ® 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 /�q
DATE By
FPPC Form 803 (January/2018)
FPPC Toll -Free Nelpline: 866/ASK-FPPC (866/275-3772)