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City/Suburb

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State/territory

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Address 2

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Law requires we ask for your employer and occupation. If you don’t have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contribution rules I am a U.S. citizen or lawfully admitted permanent resident (i.e., green card holder). I am at least eighteen years old. This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution. I am making this contribution with my own personal credit or debit card and not with a corporate or business credit card or a card issued to another person Produced by Kassandra Wilson Trustee of CJUHSD for Area 4 FPPC ID#1445396

I confirm that the above statements are true and accurate.

$ 50.00