|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
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!
|
