803 Geoffrey Kors 2022-05-13 Betty AmberBehested Payment Report
A Public Document
Type or Print In Ink.
Amendmenf of Fifing D Check box If an Amendment
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MAY 16 2022
ffice of the City Cler
1.Elected Officer or CPUC Member (Last name, First name)ELECTED OFFICER OR CPUC MEMBER:Kors, Geoffrey AGENCY NAME: f GEN CY STREET ADDRESS:City of Palm Springs 3200 E Tahquitz Canyon Way DESIGNATED CONTACT PERSON (NAME ANO TITLE):MEA CODE/PHONE NUMBER:
(760)323-8299 IE-MAIL:
geoff.kors@palmsprlngsca.gov
2.Payor Information (For additional payors, Include an attachment with the names, addresses, an d_procsedlng information)NAME: 1 ' iADDRE.SS:
□Donor Advised Fund (OAF)(see Instructions) BRIEF DESCRIPTION OF PROCEEDINGS: □ Payor Is a named party or the subject of a proceeding before my agency.
3.Pay«te l!'fOrm!'tle>11 (FCJ(�acl!'_ftlonal eayees, Include an atta_chment with the names, addresses and relationship Information)NAME: ADDRESS: Planned Parenthood of the Pacific Southwet 1075 Camino del Rio South CITY:
San Diego
CALIFORNIA
FORM 803
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 (6oard member or execuUve officer) or position on a�no!lorary or advisory board. NAME ANO TITLE: IROLE WITH THE NONPROFIT ORGANIZATION: IBRIEF DESCRIPTION: James WIiiiamson, President Board of Directors President, Board of Directors Spouse
4.P�y��"-� _lnf0!!!1!'tion. (CompleJe all Information. For estimated payment Information check the box below.)DATE AMOUNT PAYMENT TYPE(MONTH/DAY/VEAR> BRIEF DESCRIPTION OF IN-KIND PAYMENT PURPOSE DESCRIBE T�E LjpIsL�1� GOV!RNMENTAL,CHARI ABL PUR O , OR VENT: 1/ril� � �rJo �ONETARY DONATION0 IN-KIND GOODS OR SERVICES
□ The tDATEIAMouliiTJInformation.
-0 MONETARY DONATION 0 IN-KIND GOODS OR SERVICES
Is an estimate and reflects my best efforts at obtaining the accurate
B LEGISLATIVE GOVERNMENTAL, CHARITABLE ; LEGISLATIVE = GOVERNMENTAL CHARITABLE REASON FOR ESTIMATE:
5.Amendment Description and/or Comments (Provide date of original fillng or confirmation number in Part 1.J
6. ty of perjury under
Executed on 5 ( {3 / J...J=;: DATE By ;:;,C '',S' < SIGFJAIURE
Sponsorship of 2022 Stand No�I Event
FPPC Form 803 (February/2022) advice@fppc.ca.gov