803 Geoffrey Kors 2022-03-24 Bobbie and John GilbenBehested Payment Report
A Public Document
Type or Print In Ink.
Amendment-of-FIiing D Check box if an AmendmentI I (Month, Day, Year)
Date StftZ0BWED
MAR 2 4 2022
CALIFORNIA 803 FORM
# ---"'!Clf"o-n"llfll"'rm-a"'!il"'o-n"l!N""u-m .... be_r __ _ Office of the City alerk
1.Elected Officer or CPUC Member (Last name, First name) ELECTED OFFICER OR CPUC MEMBER:
Kors, GeoffreyDESIGNATED CONTACT PERSON (NAME AND TITLE):
�GENCY NAME:
City of Palm Springs F REA CODE/PHONE NUMBER:
(760)323-8299
�GENCY STREET ADDRESS:
3200 E Tahquitz Canyon Way E-MAIL:
geoff.kors@palmspringsca.gov
2.Payor Information (For additional payors, include an attachment with the names, addresses, and proceeding information)
NAr.te�hhi -c � 0'�1-.y, ?r'/btt,� Jl77 1 (c&.OAF NAME: □Donor Advised Fund (OAF) (see Instructions) BRIEF DESCRIPTION OF PROCEEDINGS: □ Payor is a named party or the subject of a proceeding before my agency.
3.Payee Information (For additional payees, Include an attachment with the names, addresses and relationship Information)NAME: ADDRESS:
Planned Parenthood of the Pacific SouthweJ,-1075 Camino del Rio South
ISOR: (SEE INSTRUCT!
CITY:
San Diego
IZIP CODE: ?}!J's 7
STATE: ZIP CODE:
CA 92108 For a nonprofit organization payee, provide a brief description of any relatlonshlp to the offlclal, offlclal's Immediate family member or staff member In the role of founder, salaried employee, decision-making capacity (1:>oard member or executive officer) or position on an honorary or advisory board. __ NAME AND TITLE: IROLE WITH THE NONPROFIT ORGANIZATION: IBRIEF DESCRIPTION:
James Williamson, President Board of Directors President, Board of Directors Spouse
4.Payment Information (Complete all information. For estimated payment information check the box below.)DATE AMOUNT PAYMENT TYPE BRIEF DESCRIPTION OF IN-KIND PAYMENT PURPOSE DESCRIBE THE LEGISLATIVEE GOVERNMENTAL, (MONTH/DAY/YEAR) CHARITABLE PURPOS , OR EVENT:
1 /)1 In '29 MONETARY DONATION B LEGISLATIVE
5/1100 GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES � CHARITABLE , □LEGISLATIVE 0 MONETARY DONATION 8 GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES CHARITABLE REASON FOR ESTIMATE: □ The (DATE/AMOUNT) Is an estimate and reflects my best efforts at obtaining the accurate Information.
5.Amendment Description and/or Comments (Provide date of original filing or confirmation number in Part 1.)
6.Verification
Sponsorship of 2022 Stand Now! Event
I certify, under penalty of perjury under ilie laws of the Stale of Calllornla, !hat to the best of m
�
the Information contained herein Is true and complete.
Executed on } /J_ Z {J J By � I D�TE IORE FPPC Form 803 (February/2022) advice@fppc.ca.gov