Contribution Form

___ Yes, I would like to help Thom Carter end the wasteful spending that has lead to large amounts of debt for our great community. I believe that with the principled leadership of Thom Carter Montgomery can achieve its potential. I will contribute: ___ $2400

___ $1000

Please make checks payable to: Please mail to:

___$500

___$250

___ Other $_______

The Montgomery Township Republican Organization Thom Carter 35 DeHart Drive Belle Mead, NJ 08502

Name: ________________________________________________________________________ Address: ______________________________________________________________________ City: _____________________________________ State: ___________ Zip: _______________ Telephone: ___________________________ Email: ___________________________________ Occupation (Required): __________________________________________________________ Employer (Required): ___________________________________________________________ Employer’s Address (Required): ___________________________________________________ Contributor Signature (Required): __________________________________________________

Election law requires political committees to use best efforts to report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 during an election cycle. An individual may not contribute more than a total of $2400 per election to the committee. Law prohibits contributions to the committee from the general treasury funds of a corporation, labor organizations or national banks (including corporate or other business entity credit cards), from any person contributing another's funds, from a Federal government contractor, or from a foreign national who lacks permanent resident status. Contributions are not deductible for Federal income tax purposes.