Run-off Account Only
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090927AML
Run-Off Account Only Please make personal checks payable to: People for John Liu (run-off) PO Box 520631, Flushing, NY 11352
Contact: 646-296-4382 [email protected] Fax: 718-679-9570
I SUP POR T JOH N LI U! HER E IS M Y C ONTR IBUT ION OF
CONTRIBUTION $2,47 Pl eas e in dica te amo unt: Cr edit Car d
$ _________
____
FOR COMMITTEE USE ONLY STATEMENT # _______________ TRANSACTION ID ___________
( MA XIMUM
5) Che ck
Cash
(up to $100) Mo ney Ord er
Credi t Ca rd Type ________________________________________________________________________________________ Account Ho lder __________________________________________________________________________________________ Account Nu mber _________ ____________ ____________ ____________ ____________ ____________ ____________ _______ Exp irat ion Da te _________________________________________________________________________________________ The follo wing info rmat ion is requi red by law for all cont ribut ions: Na me _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ ________ Ho me Addres s _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ City /State/Z ip _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ _ Phone Nu mber/E mai l _________ ____________ ____________ ____________ ____________ ____________ ____________ __ To comp ly with Campa ign F inance Bo ard repo rting requ ire ments, please give the follo wing info rma tion: Emp loye r _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ ____
Paid for by People for John Liu
090927AML
Oc cupation _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ ___ Bus iness Addre ss _________ ____________ ____________ ____________ ____________ ____________ ____________ _____ City /State/Z ip _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ I un derstand that State la w requires that a contributio n be in my name an d be f rom my own funds. I hereby af firm that t his contributio n is be ing made from my persona l f unds, is not be ing reimburse d in any manner , an d is not be ing made as a lo an; in add ition, in the case of a credit card cont rib ution, I hereby af firm that this contribution is bein g made from my perso nal credit card account, bil led to and pai d by me for my personal use, and has no corpor ate or busi ness af fil iation.
CONTR IB UT OR’ S SIGN ATURE:
DA TE O F
CONTRI BUTION : ____ ______ ______
Please note campaign contributions are not tax deductible
Paid for by People for John Liu
Run-Off Account Only Please make personal checks payable to: People for John Liu (run-off) PO Box 520631, Flushing, NY 11352
Contact: 646-296-4382 [email protected] Fax: 718-679-9570
I SUP POR T JOH N LI U! HER E IS M Y C ONTR IBUT ION OF
CONTRIBUTION $2,47 Pl eas e in dica te amo unt: Cr edit Car d
$ _________
____
FOR COMMITTEE USE ONLY STATEMENT # _______________ TRANSACTION ID ___________
( MA XIMUM
5) Che ck
Cash
(up to $100) Mo ney Ord er
Credi t Ca rd Type ________________________________________________________________________________________ Account Ho lder __________________________________________________________________________________________ Account Nu mber _________ ____________ ____________ ____________ ____________ ____________ ____________ _______ Exp irat ion Da te _________________________________________________________________________________________ The follo wing info rmat ion is requi red by law for all cont ribut ions: Na me _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ ________ Ho me Addres s _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ City /State/Z ip _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ _ Phone Nu mber/E mai l _________ ____________ ____________ ____________ ____________ ____________ ____________ __ To comp ly with Campa ign F inance Bo ard repo rting requ ire ments, please give the follo wing info rma tion: Emp loye r _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ ____
Paid for by People for John Liu
090927AML
Oc cupation _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ ___ Bus iness Addre ss _________ ____________ ____________ ____________ ____________ ____________ ____________ _____ City /State/Z ip _________ ____________ ____________ ____________ ____________ ____________ ____________ ________ I un derstand that State la w requires that a contributio n be in my name an d be f rom my own funds. I hereby af firm that t his contributio n is be ing made from my persona l f unds, is not be ing reimburse d in any manner , an d is not be ing made as a lo an; in add ition, in the case of a credit card cont rib ution, I hereby af firm that this contribution is bein g made from my perso nal credit card account, bil led to and pai d by me for my personal use, and has no corpor ate or busi ness af fil iation.
CONTR IB UT OR’ S SIGN ATURE:
DA TE O F
CONTRI BUTION : ____ ______ ______
Please note campaign contributions are not tax deductible
Paid for by People for John Liu
