803 Geoffrey Kors 2022-03-24 Wally KlemBehested Payment Report
A Public Document
Type or Print In Ink.
Amendment of FIiing D Check box if an Amendment I I (Month, bay, Year)
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Date S�(4gtqcy) REC�l v r.,u
MAR 2 4 2022
1.Elected Officer or CPUC Member (Last name, First name)ELECTED OFFICER OR CPUC MEMBER: �GENCY NAME: �GENCY STREET ADDRESS:
Kors, Geoffrey City of Palm Springs 3200 E Tahquitz Canyon Way DESIGNATED CONTACT PERSON (NAME AND TITLE): �REA CODE/PHONE NUMBER:
(760)323-8299
E-MAIL:
geoff.kors@palmsprlngsca.gov
2.Payor Information (For additional payors, include an attachment with the names, addresses, and proceeding information) NAME: !ADDRESS:
□Donor Advised Fund (OAF) (see Instructions)
;OAF NAME:
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 relatlonshlp Information)NAME: ADDRESS:
Planned Parenthood of the Pacific Southw�f 1075 Camino del Rio South
l-« ]1;/IF!
CITY:
San Diego
CALIFORNIA 803 FORM
STATE: ZIP CODE:
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 (ooard_ll'lember 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:
J /}Jl1J � MONETARY DONATION B LEGISLATIVE
�I Pf, GOVERNMENTAL IN-KIND GOODS OR SERVICES @ CHARITABLE ' 0 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.VerificationI __ _.,;z_ .. _s __ .
Executed on "J>/J U;J= By »<== ' ' � -... < f Eh.kli ii JDC
Sponsorship of 2022 Stand Now! Event
FPPC Form 803 (February/2022) advice@fppc.ca.gov