803 Geoffrey Kors 2022-04-26 Lynne CarlsonBehested Payment Report
A Public Document
Type or Print In Ink.
1.Elected Officer or CPUC Member (Last name, First name)ELECTED OFFICER OR CPUC MEMBER:
Kors, GeoffreyDESIGNATED CONTACT PERSON (NAME AND TITLE):
�GENCY NAME:
Amendment of Fifing
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Date Stamp (Agency) O Check box If an Amendment f E C E l y ED' /Ci T Y O P A L M SPRINGSonth, bay, Year)
# 2022 A R 2 6 AM II : I IConflnnadon Number UFFICE OF H·lf CiTY CLF.·�GENCY STREET ADDRESS:
City of Palm Springs 3200 E Tahquitz Canyon Way r REA CODE/PHONE NUMBER:(760)323-8299 [E-MAIL:
geoff.kors@palmsprlngsca.gov
2.Payor Information (For additional psyors, Include an attachment with the names, addresses, and proceeding Information)NAfyiE: aADDRESS:
□Donor Advised Fund (OAF)(see Instructions) RIEF DESCRIPTION OF PROCEEDINGS: □ Payor Is e named party or the subject of a proceeding before my agency.
3.Paree Information (For additional payees, Include an attachment with the names, addresses and relationship Information)NAME: �DDRESS:
Planned Parenthood of the Pacific Southwet 075 Camino del Rio South
CITY:
San Diego
CALIFORNIA 803 FORM
STATE: CA 1�/J/l,
STATE: ZIP CODE:
CA 92108 For a non_proflt 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, deci sion-making capacity (board member or execuUve officer) or position on an honorary or advisory board. NAME AND TITLE: IROLE WITH THE NONPROFIT ORGANIZATION: l9RIEF DESCRIPTION:
James WIiiiamson, President Board of Directors President, Board of Directors ISpouse
4.Parment Information (Complete all Information. For estimated payment Information check the box below.)DATE AMOUNT PAYMENT TYPE BRIEF DESCRIPTION OF IN-KIND PAYMENT PURPOSE DESC�BE THE LEj��TI� G�VERN�ENTAL,(MONTH/DAY/YEAR> HARITABL RPO ;, 0 EVE :
/0,IJIJ/J □ MONETARY DONATION B LEGISLATIVE7./ It /111-GOVERNMENTAL □ IN-KIND GOODS OR SERVICES '; CHARITABLE
✓' I -I □ MONETARY DONATION � LEGISLATIVE : GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES CHARITABLE REASON FOR ESTIMATE: Is an estimate and reflects my best efforts at obtaining the accurate□ The t0ATEiXU00Rt1 Information.
5.Amendment Description and/or Comments (Provide date of origins/ filing or confirmation number in Part 1.J
8.
Executed on 1 « n< , _ -
Sponsorship of 2022 Stand NoY'I Event
FPPC Form 803 (February/2022) advlce@fppc.ca.gov