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Committee in Formation
For a reception to support 2012 Candidate for Brooklyns 10th Congressional District
By federal law, the maximum contribution is $2,500 per individual or $5,000 per couple.
To make a contribution, or for more information, please go to www.JeffriesforCongress.com or complete the attached form.
Please RSVP by March 5th to Jacquisam77@gmail.com, or call 347-770-0010 for more information.
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By law, the maximum amount an individual may contribute is $2,500 ($5,000 per couple) per election cycle. (The primary and general are separate elections.) Federal multi-candidate PACs may contribute $5,000 per election. Federal law requires us to obtain and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 per election cycle. Contributions by corporations, foreign national, labor unions, federal government contractors and minors under the age of 18 are prohibited.
Contributor Information First Name: Address: City: Home Phone: Email: Employer: (required) Work Phone: Other Phone: Occupation: (required) State: Zip: Fax (if applicable): Last Name:
I am at least 18 years of age. This contribution is made from my personal funds and not from those of a corporation or labor organization. I am not a federal government contractor. I am a U.S. citizen or permanent resident and this contribution will not be reimbursed by another person
Signature: Joint Contributor Information (if applicable) First Name: Address: City: Home Phone: Email: Employer: (required) Work Phone: Other Phone: Occupation: (required) State: Zip: Fax (if applicable): Last Name:
For a contribution from a joint account to be attributed to two individuals, both must sign this form, indicating agreement with the above statement. Signature:
To contribute go to www.JeffriesforCongress.com or mail your contribution along with this form to:
Lauren Bierman,The Advance Group, 39 Broadway Suite 1540, New York, NY 10006
Contributions are not tax deductible as charitable contributions for federal income tax purposes.