Friends of Dr. Irene Pinkard for Oxnard City Council Donation Form

 

Name:

 

 ____________________________________________

 
Address:

 

 

 ____________________________________________

____________________________________________

 
Occupation:

 

 ____________________________________________

 
Employer:

 

 ____________________________________________

 
Email Address:

 

 ____________________________________________

 

Check this box to confirm that the following statements are true and accurate:

1) I am a United States citizen or a permanent resident alien. 2) This contribution is not made from the general treasury funds of a corporation, labor organization or national bank. 3) This contribution is not made from the treasury of an entity or person who is a federal contractor. 4) The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.


If Paying by Check:

Please make your check payable to the Friends of Dr. Irene Pinkard.

If Paying by Credit Card:

Card Number:

 

 ____________________________________________

 
Expiration Date:

 

 ____________________________________________

 
Signature:

 

 ____________________________________________

 

Your contribution is not tax-deductible as a charitable contribution for Federal income tax purposes.

Federal Election law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Your contribution will be used in connection with Federal elections and is subject to the limits and prohibitions of the Federal Election Campaign Act.

Source Code: NETA507