803 Geoffrey Kors 2022-02-17 Lauren Roberson and Jennifer FlynnCIT y ECE1'"'ED
Behested Payment Report A Public Document Pa Lf'�S pp 14,Behe•tedPaymodR•pwt
1. Elected Officer or CPUC Member (Last name, First name) 1 EB, • e
Kors, Geoffrey l : �2 •
Agency Narne Tf F_ r For in Use Only
City of Palm Springs � `') � Y C � [
Agency Street Address
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, Hdifferent)
❑ Amendment (See Part 5)
Area Code/Phone Number
E-mail (optionao
Date of Original Filing:
760-323-8299
(month, day, year)
Z. Payor Information (For additional payors, include an attachment with the names and addresses.)
Name
Zip Code
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 (c plate all information.)
Date of Payment: Z�ILAmount of Payment: (ln-K/nd M9 $(hioA
th,
y, r)
(Round to wholebdoftars)
Payment Type: ICI Monetary Donation or ❑ In -Kind Goods or Services
(P►ovide 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 —L d-)— By
DATE
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: N6/A5K-FPPC (866/275-3772)