803 Geoffrey Kors 2022-05-13 Stacy and Rick ValenciaBehested Payment Report A Public Document
Type or Print In Ink.
Amendment of Fllfng D Check box If an Amendment
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MAY 16 2022
CALIFORNIA 803 FORM
#---•c!!!'o-n""!fi,.rm-at"'ion-N!'l'u•m""!S""e_r __ _ Office of the City Cle IE
1.Elected Officer or CPUC Member (Last neme, First name)
ELECTED OFFICER OR CPUC MEMBER:
Kors, Geoffrey
DESIGNATED CONTACT PERSON (NAME ANO TITLE):
�GENCY NAME:
City of Palm Springs
AREA CODE/PHONE NUMBER:
(760)323-8299
AGENCY STREET AD D RESS:
3200 E Tahquitz Canyon Wa y
f•MAIL:
geoff.kors@palmsprlngsca.gov
2.Payor Information (For edditiona/ payors, Include an attachment with the names, addresses, an d proceeding information)NAME: _ fADORESS:
r}I;/ �
BRIEF DESCRIPTION OF PROCEEDI NGS: □ 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
IP-CODE:
(! ,1-
STATE: ZIP CODE:
CA 92108
For a nonprofit organization payee, provide a brief description of any relationship to the official, official's Immediate family member or staff member In the role of founder, salaried employee, decision-makingcapacity (f>oard member or executive officer) or position on an honorary or advisory board, NAME ANO TITLE: 'ROLE WITH THE NONPROFIT ORGANIZATION: 'BRIEF DESCRIPTION:
James Williamson, President Board of Directors President, Board of Directors Spouse
4.eayment Information (Complete all Information. For estimated payment Information check the box below.)
DATE AMOUNT PAYMENT TYPE (MONTH/DAY/YEAR) BRIEF DESCRIPTION OF IN-KIND PAYMENT PURPOSE DESCRIBE T1l LEGISLATI� GOVERNMENTAL,CHARI BLE PURPO , OR EVENT:
9/J.3/}) �NETARY DONATION B LEGISLATIVE GOVERNMENTAL Sponsorship of 2022 Stand No�! Event/;J\ /JV ( J 0 IN-KIND GOODS OR SERVICES � CHARITABLE
/ I I □ MONETARY DONATION � LEGISLATIVE □ IN-KIND GOODS OR SERVICES : GOVERNMENTAL CHARITABLE REASON FOR ESTIMATE: □ The ll5ArEtAMoul3n Is an estimate and reflects my best efforts at obtaining the accurate
Information.
5.Amendment Description and/or Comments (Provide date of original fl/Ing or confirmation number in Part 1.)
6.Verification I certify, under penalty of perjury under the laws of the State of Calttomla, that to the 6 s f my knowledge, the information contained herein Is true and complete.
Executed on I l I lJ )--)_ By ___ _,....._..,.,..,,...�-------"'fflP.!!l'l'll"ll'T"ft'Jl�----------oATE FPPC Form 803 (February/2022)
advlce@fppc.ca.gov