803 Geoffrey Kors 2022-05-05 WalmartBehested 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 Filing D Check box if an Amendment I I (Month, Day, Year)
# ---"'!CP o-n-=fi-rm-a"'!ti""·o -n"'N"'u_m.,.6_e_r ---
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 92262 DESIGNATED CONTACT PERSON (NAME AND TITLE):;E-MAIL: I �REA CODE/PHONE NUMBER:
760-323-8299 geoff.kors@palmpringsca.gov
2.Payor Information (For additional payors, include an attachment with the names, addresses, and proceeding information) NAME: r iADDRESS:
AF NAM-E: �
RIEF 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 relationship Information) NAME: ADDRESS:
Boys & Girls Club of Palm Springs 450 S. Sunrise Way
CITY:
Palm Springs
ZIP CODE:
/J')-)�
STATE: ZIP CODE:
CA 92262
For a nonprofit organization payee, provide a brief description of any relatlonshlp to the offlclal, offlclal's Immediate family member or staff member In the role of founder, salaried employee, decision-making capacity (1::>oard member or executive officer) or position on an honorary or �visory board. NAME AND TITLE: IROLE WITH THE NONPROFIT ORGANIZATION: 'BRIEF DESCRIPTION:
Geoffrey Kors, President Board of Directors President Board of Directors Self
4.��yrnen�Jnfo_rm�t!on (Qomplete 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: o{(o)/)_ y,,u IA.._MONETARY DONATION B LEGISLATIVE GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES @ CHARITABLE □LEGISLATIVE 0 MONETARY DONATION 8 GOVERNMENTAL 0 IN-KIND GOODS OR SERVICES CHARITABLE REASON FOR ESTIMATE: D The coXTEJAMouNT) 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.Verification
Sponsorship of 2022 Fundraising Event
I __ _.,12. ___ :; __ . ereln is true and complete.
FPPC Form 803 (February/2022)
advice@fppc.ca.gov