RECEIPT - QUALIFIED CONTRIBUTION FOR FAIR ELECTIONS FUNDS
Thank you for donating to Laura's campaign for District 1! We're using Berkeley's Public Financing Program, which limits donations to $60. Donations by Berkeley residents are matched 6:1 by the city. This is an easier way to submit the paperwork required. Questions? Email info@laura4berkeley.com.
Amount:
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Maximum of $60
Payment Method
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Check
Credit/Debit
Money Order
Online Payment
Cash
Name
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First Name
Middle Initial
Last Name
HOME ADDRESS
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Home Address
Apt/Suite/Floor
City
State / Province
Postal / Zip Code
TELEPHONE (if any)
Format: (000) 000-0000.
EMAIL ADDRESS (if any)
example@example.com
To comply with reporting requirements, individuals must provide occupation and employer. If you are not employed, indicate what best describes your employment status (e.g., "homemaker," "student," "retired," or "unemployed"). If self-employed, enter the name of the business and city of employment.
OCCUPATION
*
EMPLOYER
*
IF SELF-EMPLOYED, ENTER BUSINESS NAME AND CITY
I understand that the purpose of this contribution is to help the above-named candidate qualify for Fair Elections campaign funding as prescribed by the Berkeley Charter, Article III (Elections) and Berkeley Municipal Code Chapter 2.12 (Election Reform Act). I have made this contribution without coercion or reimbursement. I certify that I am a Berkeley resident.
CONTRIBUTOR SIGNATURE
*
DATE
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Month
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Day
Year
Date
Submit
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