Electronic Transfer
 
     
   

Personal Information

Employer Information

To comlpy with State and Federal law, we must use best efforts to obtain, maintain, and submit the name, mailing address, occupation and name of employer of individuals who’s contributions exceed $100 per calendar year.

Contribution Amount






I confirm that all of the following statements
are true and accurate:

a. am a United States citizen or a permanent resident alien.
b. I am making this contribution from my own funds, and not those of another.
c. I am making this contribution on my own personal credit card and not with a corporate or business credit card or a credit card issued to anyone else.
d. I am at least 18 years of age.


 
   
     



 
 
 
PAID FOR BY THE COMMITTEE TO ELECT PAUL GONZALES (D)
PO BOX 1133, MOUNT VERNON, WA 98273
 
 

 

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