803 Geoffrey Kors 2022-03-24 Marcia HazaBehested Payment Report
A Public Document Type or Print In Ink.
Amendment of Filing D Check box if an Amendment
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Dat'IM(!'JEJWD
MAR 2 4 2022
CALIFORNIA 803 FORM
# _____ Co,_n_,,fi_rm_a..,tlo-n""N-um ... b_e_r --Office of the City CleJrk
1.Elected Officer or CPUC Member (Last name, First name) ELECTED OFFICER OR CPUC MEMBER:
Kors, Geoffrey
DESIGNATED CONTACT PERSON (NAME AND TITLE):
rGENCY NAME:
City of Palm Springs
�REA CODE/PHONE NUMBER:
(760)323-8299
AGENCY 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)
NAMih
t{r[ ;R lb zev-rn;� r,,/nl) f.µ
;OAF NAME: DONOR(S)AND DONOR'SADVTSOR:-(SEE lNSTRUCTI0NS:) D Donor Advised Fund (OAF) (see instructions) :BRIEF DESCRIPTION OF PROCEEDINGS: D 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 relatl<!_nshle_ln_formatio'!)NAME: ADDRESS:
Planned Parenthood of the Pacific Southwej'( 1075 Camino del Rio South
CITY:
San Diego
TATE: Cl!
STATE: ZIP CODE:
CA 92108
For a nonprofit organization payee, provide a brief description of any relationship to the offlclal, offlclal's immediate family member or staff member In the role of founder, salaried employee, decision-making capacity (ooard 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 inrormation c�e_ck !h� b�_�e_l<!_w_-l
DATE AMOUNT PAYMENT TYPE BRIEF DESCRIPTION OF IN-KIND PAYMENT PURPOSE DESCRIBE THE LEGISLATIVEE GOVERNMENTAL, (MONTH/DAY/YEAR) CHARITABLE PURPOS , OR EVENT:
'J(Jf/]] � MONETARY DONATION B LEGISLATIVES�111� GOVERNMENTAL IN-KIND GOODS OR SERVICES 0:, CHARITABLE 0 MONETARY DONATION LEGISLATIVE : GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES � CHARITABLE REASON FOR ESTIMATE: D The (oArEiAMoUNTl Is an estimate and reflects my best efforts at obtaining the accurate information.
5.Amendment Description and/or Comments (Provide date of original fifing or confirmation number in Part 1.)
6.Verification
Sponsorship of 2022 Stand Now! Event
I certify, under penarty or perjury unaer
Executed on 1,,/Jrh d-
information contafned herelnTs true and complete.
r DATE By <:rz::: _,_..,,J< <;.u1.Nx111u.: FPPC Form 803 (February/2022) advice@fppc.ca.gov