803 Geoffrey Kors 2022-05-13 Nara Taylor JaffeBehested Payment Report
A Public Document
Type or Print In Ink.
Amendn"fent of-Flllng D Check box If an Amendment
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Date Stamp (Agency)
RECEIVED
MAY 16 2022
1.Elected Officer or CPUC Member (Last name, First name) ELECTED OFFICER OR CPUC MEMBER:AGENCY NAME: �GENCY STREET ADDRESS: Kors, Geoffrey City of Palm Springs 3200 E Tahquitz Canyon Way DESIGNATED CONTACT PERSON (NAME ANO TITLE):E-MAIL:rREA CODE/PHONE NUMBER:(760)323-8299 geoff.kors@palmsprlngsca.gov
2.Payor Information (For additional payors, Include an attachment with the names, addresses, and proceeding Information)NAME: f C) "1 / ur T q, ��r?-Rqj' L/ £1 IM 17J1,,m p.)
□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.Payee Information (For additions/ payees, Include an attachment with the names, addresses and relationship Information)NAME: ADDRESS: Planned Parenthood of the Pacific Southwet 1075 Camino del Rio South
.)
CITY:
San Diego
CALIFORNIA 803 FORM
IP-CODE: '!1v 3-,
STATE: ZIP CODE:
CA 92108
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 (t;oard member or executive offl_c:eJ'l�r posltlo1_1__Qn an hono_l!lry or advisory board, NAME ANO TITLE: IROLE WITH THE NONPROFIT ORGANIZATfON: fBRIEF DESCRIPTION: James WIiiiamson, President Board of Directors President, Board of Directors lspouse
4.�ayment Information (Complete all Information. For estimated payment Information check the box below.)CATE AMOUNT PAYMENT TYPE BRIEF DESCRIPTION OF IN-KIND PAYMENT DESCRIBE T�l LEGISL�I � GOVERNMENTAL,(MONTH/DAY/YEAR> PURPOSE CHARI BLE PUR O , OR EVENT:
lf-/ lf l }-1-lo� oou l2J_MONETARY DONATION D IN-KIND GOODS OR SERVICES
D MONETARY DONATION 0 IN•KINO GOODS OR SERVICES □ The (6ATE7AMOUNT) Is an estimate and reflects my best efforts at obtaining the accurate
Information.
B LEGISLATIVE GOVERNMENTAL, CHARITABLE -LEGISLATIVE: GOVERNMENTALCHARITABLE REASON FOR ESTIMATE:
5.Amendment Description and/or Comments (Provide date of original filing or confirmation number in Part 1.J
6. Verificationr __ _.,z/1 ··-!I--I
Sponsorship of 2022 Stand No�! Event
FPPC Form 803 (February/2022)
advlce@fppc.ca.gov