Name of Contributor(Required) Residential Address(Required) Email(Required) Phone(Required) Donation Amount(Required) How Did you Pay(Required) Cash Check Please note there is a $100 maximum if donating by cash.Check Number Where did you donate?(Required) Event Mailed Hand Delivered Occupation Employment Are you a Lobbyist ? Are you the spouse or the dependent child of a Lobbyist ? I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief. YES NO I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. YES NO I certify that this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution. YES NO Cerfitication(Required) yes No I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief. I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States. I certify that this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.
