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1. I am a United States citizen or an individual lawfully admitted with
permanent residence status (ex. a green card holder)
2. This contribution is made from the funds of the donor identified
above, and not those of another.
3. Donor is not a foreign national who lacks permanent resident
status in the United States.
4. This contribution is not made from the treasury of an entity or person
who is a federal contractor (does not apply to personal contributions
by subcontractors, employees, partners, shareholders or officers of federal contractors).
5. This contribution is made on a credit or debit card of the donor listed
for which the donor has legal obligation to pay, and is not made on the card of another.
Contributions are not tax deductible for federal income tax purposes.
Contributions from foreign nationals and federal government contractors are prohibited.
Federal law requires us to use our best efforts to collect and report the name, mailing address,
occupation, and employer of individuals whose donations exceed $200 in an election cycle.
Please list your Employer and Occupation in the boxes above.
