To comply with Federal law, we must use best efforts to obtain,
maintain, and submit the name, mailing address, occupation and name of
employer of individuals whose contributions exceed $200 in an election
If not employed, enter "none"
I confirm that the following statements are true and accurate:
- I am not a foreign national who lacks permanent residence
in the United States.
- I am not a Federal government contractor.
- This contribution is made from my own funds, and not those
- This contribution is not made from the funds of a
corporation or labor organization.
- This contribution is made on a personal credit card or
debit card for which I have the legal obligation to pay, and is not
made either on a corporate or business entity card or on the card of
- I am at least eighteen years old.