803 Geoffrey Kors 2022-03-24 Jill Skrezyna and Alex SunBehested Payment Report Amendment of Filing Data ftntlnb
A Public Document ❑ Check box if an Amendment
Type or Print In Ink. on ay, ear MAR 2 4 2022
# onfinnaton um er Office of the City Ci
1. Elected Officer or CPUC Member (Last name, First name)
ELECTED OFFICER OR CPUC MEMBER: AGENCY NAME: AGENCY STREET ADDRESS:
Kors, Geoffrey City of Palm Springs 3200 E Tahquitz Canyon Way
DESIGNATED CONTACT PERSON (NAME AND TITLE): AREA CODE/PHONE NUMBER: E-MAIL:
(760) 323-8299 geoff.kors@palmspringsca.gov
2. Payor Information (For additional payors, include an attachment with the names, addresses, and proceeding information)
NAME: DDRESS: CITY: STATE: ZIP CODE:
U (..I Ales SUS t l�� s i s ffl N I C,/ '7 o 3
DAF NAME: DONOR( )AND DON R'S VISOR: (SEE INSTRUCTIONS.)
❑ Donor Advised Fund (DAF)
(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: CITY: STATE: ZIP CODE
Planned Parenthood of the Pacific Southwc 1075 Camino del Rio South San Diego CA 92108
For a nonprofit organization payee, provide a brief description of any relationship to the official, official's Immediate family member or staff member In the role of founder, salaried employee, decision -making
capacity (board member or executive officer) or position on an honorary or advisory board.
NAME AND TITLE: ROLE WITH THE NONPROFIT ORGANIZATION: BRIEF 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.)
MONTHD/DAYlYEAR AMOUNT PAYMENT TYPE BRIEF DESCRIPTION OF IN -KIND PAYMENT PURPOSE DESCRIBE
CHATHE LEGISLATIVE
PURPOSE GOVERNMENTAL,
E RNMENTAL,
MONETARY DONATION LEGISLATIVE Sponsorship of 2022 Stand Nowl Event
8 GOVERNMENTAL
❑ IN -KIND GOODS OR SERVICES r CHARITABLE
❑ MONETARY DONATION ❑ LEGISLATIVE
IN -KIND GOODS OR SERVICES GOVERNMENTAL
❑ CHARITABLE
REASON FOR ESTIMATE:
❑ The (DATE AMOUNT) is an estimate and reflects my best efforts at obtaining the accurate
5. Amendment Description and/or Comments (Provide date of original Oiling or confirmation number in Part 1.)
6. Verification
i ceniTy, unaer penairy oT pequ�ryunaer ine laws oT me state OT �aurornla, tnat to Tne nest T my
Executed on 4� a Ud By
DATE
FPPC Form 803 (February/2022)
advice@fppc.ca.gov