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Paid for by
Friends of Toby Nixon
12113 NE 141st St.
Kirkland WA 98034


Mail Your Contribution to Toby’s Campaign

Please print this page, fill it out, and mail it with your check or credit card information to the address below.


Name
Address
City State
Zip
Email
Home Phone Work Phone
Employer
Emp City
Emp State
Occupation
 
Amount of Contribution
__$800

__ $100

__ $500

__$50

__ $250

__ $25


__ other ______________
 
Credit Card Contributions
Card Type:   ___Mastercard   ___Visa   ___Discover   ___Amex
Card Number:   __________________________________________
Expiration Date:   ______/_______
Amount:   ______________
Name On Card:   __________________________________________

State law requires us to use our best efforts to collect and report the name and mailing address for all contributors, and the occupation and name of employer of individuals who contribute more than $100 in a calendar year.

Political donations are not tax deductible for Federal Income Tax purposes.

Contributions are limited to $800 per person ($1600 per couple) and $800 per business, through the entire campaign cycle. Contributions in excess of these amounts will be returned.

Please make your check payable to “Friends of Toby Nixon”, and mail this page with your check to:

Friends of Toby Nixon 
12113 NE 141st Street
Kirkland, WA 98034

Thanks for your support!