Friends of Donovan Richards 2013

Intermediary: Progressive Caucus Alliance

Date: ____________

Amount: _________

____ Check (Check #: __________)

____ Money Order

Please make out one check per candidate, payable to Friends of Donovan Richards 2013.

Name__________________________________________________________________________________________________________________
Home Address________________________________________________________________________________________________________
City/State/Zip_________________________________________________________________________________________________________
The following information is for internal purposes only and will not appear in public disclosure filings:

Home# __________________________________ Work #___________________________Cell # ____________________________________

E-Mail__________________________________________________________________City Council District (if known)_____________
To comply with Campaign Finance Rules, please provide the following information:

Employer*_______________________________________________Occupation_________________________________________________
Business Address______________________________________________City/State/Zip________________________________________
*For public disclosure purposes, please indicate if you are retired, a homemaker, a student, or self-employed.
The following statement is required by NYC Campaign Finance Board Rules: I understand that State law requires that a contribution
be in my name and be from my own funds. I hereby affirm that this contribution is being made from my personal funds, is not
being reimbursed in any manner, and is not being made as a loan.

_______________________________________________________Contributors Signature __________________ Date of Contribution

Doing Business Restrictions: If a contributor has business dealings with the City as defined in the Campaign Finance Act, such
contributor may contribute only up to $250 for city council, $320 for Borough President, and $400 for mayor, comptroller, or
public advocate. If you are doing business with the City, please complete the following (for more information on the doing
business rules, see www.nyccfb.info/doingbusiness).
City Agency/Agencies
Name & Address of Doing Business Entity
Business Category (e.g. contracts)
Relationship(s) (e.g. CEO)
Contribution Requirements:
Maximum contribution is $2,750. We cannot accept: contributions from corporations, partnerships, LLCs, political committees,
or foreign nationals; cash contributions that are more than $100.
Contributions are not tax deductible.
Contributions by eligible NYC residents may be matched by as much as 6:1 through the NYC Campaign Finance system.
State law prohibits making a contribution in someone elses 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.

Thank you very much!

Friends of Donovan Richards 2013 Progressive Caucus Alliance P.O. BOX 150466 Brooklyn, NY 11215