FRIENDS OF KEVIN KIM
Rhoda Weinstein, Treasurer
P.O. Box 604903Bayside, New York 11360Approval Code:__________________________ Transaction ID #: ___________________
Enclosed please find my contribution of:
$ _______________
PLEASE CHECK: Check Money Order Cash Credit Card
Please charge my: Visa MasterCard AMEX
Credit Card No:____________________________ Exp. Date: ________ Security Auth. Code: _______ Please bill my credit card in _______ monthly installments of $___________ for a total of $__________.
* Please notify the Committee if you wish to suspend installment contributions at any time*
Please make checks payable to:
“
FRIENDS OF KEVIN KIM
”
The following information and statement is required by NYC Campaign Finance Board Rules:
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AME
:H
OME ADDRESS
:C
ITY
:
S
TATE
:
Z
IP
:O
CCUPATION
:
E
MPLOYER
:E
MPLOYER
A
DDRESS
:C
ITY
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TATE
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Home Phone: _____________________ Cell Phone: ____________________ Email: _____________________ [ ] Please contact me about opportunities to volunteer with Kevin’s campaign![ ] I would like to further support Kevin’s campaign by hosting a fundraiser at my home!I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that thiscontribution is being made from my personal funds, is not being reimbursed in any manner, and is not being made as a loan; inaddition, in the case of a credit card contribution, I also hereby affirm that this contribution is being made from my personalcredit card account, billed to and paid by me for my personal use, and has no corporate or business affiliation.
Signature required: __________________________________ Date:____________________
*For contributions of more than $250: Please complete “Doing Business” questionnaire.
Contributions from NYC residents up to $175 will be matched 6 to 1 by the NYC Campaign Finance Board.
The maximum contribution for an individual to the campaign is $
2
,
750.
Contributions from corporations, LLPs, LLCs & unregistered political committees are NOT accepted.
Federal law prohibits contributions from foreign nationals;
however,
Permanent Residents or Green Card holdersare eligible to contribute. Contributions are not tax deductible
State law prohibits making a contribution in someone else’s name, reimbursing someone for a contribution made in your name,being reimbursed for a contribution made in your name, or claiming to have made a contribution when a loan is made.
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