Please print this page, fill in ALL fields, and send along with your check to:
Jean Fuller for Assembly
P.O. Box 12889
Bakersfield, CA 93389
| Name | _____________________________________________________________ |
| Address | _____________________________________________________________ |
| City | ________________________________ State _______ Zip ___________ |
| Phone | ________________________________ |
| _____________________________________________________________ | |
| Employer | _____________________________________________________________ |
| Occupation | _____________________________________________________________ |
Enclosed is a check for $___________ made payable to: Jean Fuller for Assembly. Please, do not send cash.
I designate my contribution(s) to Jean Fuller for Assembly, as follows, the first $2,300 for the 2008 ____ primary, and any additional amount that I contribute up to $2,300 for the 2008 general election. I am making this contribution with my own personal funds and not with funds provided by any other person.
| Your Signature | _____________________________________________________ |
| Second Signature (for joint accounts) |
_____________________________________________________ |
Contribution Code: JeanFuller.com
Federal election law requires Jean Fuller for Assembly to use our best efforts to collect and report the name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in an election cycle. Your contribution is not tax-deductible for federal income tax purposes.
An individual may contribute a maximum amount of $2,300 per election (the primary and general are separate elections) to a federal candidate. Federal multi-candidate political action committees (PACs) may contribute $5,000 per election. Contributions from corporations, labor organization treasury funds, foreign nationals, and federal government contractors are prohibited. All contributions must be from the contributor's personal funds. Corporations and individuals are strictly prohibited from reimbursing another person for making a contribution to Jean Fuller for Assembly.