803 Geoffrey Kors 2022-05-05 Los Casuelas TerrazaBehested 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: �GENCY NAME:
Amendment of Fifing D Check box if an AmendmentI I (Month, Day, Year)
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Date Stamp (Agency)
RECEIVED
MAY 5 2022
�GENCY STREET ADDRESS:
CALIFORNIA 803 FORM
Kors, Geoffrey City of Palm Springs 3200 E Tahquitz Canyon Way, Palm Springs, CA 92262DESIGNATED CONTACT PERSON (NAME AND TITLE):�REA CODE/PHONE NUMBER:
760-323-8299
E-MAIL:geoff.kors@palmpringsca.gov
2.Payor Information (For additional payors, include an attachment with the names, addresses, and proceeding information)N�ME: _ iADDRESS:
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: Boys & Girls Club of Palm Springs 450 S. Sunrise Way
%01
CITY:
Palm Springs
STATE: ZIP CODE:
CA 92262 For a nonprofit organization payee, provide a brief description of any relatlonshlp to the official, offlclal's Immediate family member or staff member In the role of founder, salaried employee, decision-making capacity (l:>oard member or executive officer) or position on a11__1'\gne>ra_ry_ or advl�ry board. __ __ NAME AND TITLE: IROLE WITH THE NONPROFIT ORGANIZATION: l9RIEF DESCRIPTION: Geoffrey Kors, President Board of Directors President Board of Directors ISelf
4.Payment Information (Complete all information. For estimated payment information check the box below.)DATE (MONTH/DAY/YEAR) AMOUNT PAYMENT TYPE BRIEF DESCRIPTION OF IN-KIND PAYMENTI PURPOSE I DESCRIBE THE LEGISLATIVE"' GOVERNMENTAL, CHARITABLE PURPOSc1 OR EVENT:
Oo/ 1/J ,1�1 s I II L�
0 MONETARY DONATION CJ IN-KIND GOODS OR SERVICES r , I o IB LEG1sLAT1vE is .
n21_1< I-_ IA'!_•.,, ft nf _f_&ft
0
���!�':�tAL ponsorsh1p of 2022 Fundraislng Event
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2]The 11J;�{_ Information.
0 MONETARY DONATION 0 IN-KIND GOODS OR SERVICES
Is an estimate and reflects my best efforts at obtaining the accurate
0 LEGISLATIVE B GOVERNMENTAL CHARITABLE REASON FOR ESTIMATE:
5.Amendment Description and/or Comments (Provide date of original filing or confirmation number in Part 1.)
6.Verification
O<;(.b$IU Executed on !DATE By >,< « FPPC Form 803 (February/2022) advice@fppc.ca.gov