RICARDO

LARA
DEMOCRAT STATE SENATE
Ricardo Lara for Senate 2012
c/o Niko Consulting, 550 S Hope Street, Suite 1910, Los Angeles, CA 90071

In order to comply with state law, please provide the following information:
NAME OF CONTRIBUTOR_______________________________________________
STREET ADDRESS ____________________________________________________
CITY _______________________ STATE ________
ZIP __________________
PHONE __________________________ FAX ____________________________
EMPLOYER ________________________________________________________
OCCUPATION ________________________________________________________
IF SELF-EMPLOYED, NAME OF BUSINESS ______________________________

For questions, contact (818) 715-1128 / rsvp@nikoconsulting.com

Make checks payable to Ricardo Lara for Senate 2012 (ID # 1342322)
and send to the address listed above, or fax to (818) 715-1127
We accept the following credit cards:

Visa

MasterCard

American Express

Credit Card Number _______________________________________________ Exp. Date ___________

Name on card ________________________________________________________________________
Signature ____________________________________________________________________________
Contribution Amount:

_______________________________________________________________

Contributions to Richard Lara for Senate 2012 (ID # 1342322) are not tax deductible as charitable
contributions for federal income tax purposes. The California Political Reform Act places limits on
contributions to candidates for state office. Individuals, corporations, unions, PACs, and other entities may
contribute a maximum of $3,900 to the committee per election, primary and general, for a total of $7,800. A
registered small contributor committee may contribute a maximum of $7,800 per election, for a total of
$15,600. Spouses and domestic partners may each contribute from a joint account but both must sign the
check or credit card authorization form. Contributions must be made from the donors own funds and may
not be reimbursed by any other person. Contributions from foreign nationals or persons under the age of
eighteen are not permitted. Paid for and authorized by Lara for Senate 2012 (ID No. 1342322)
Computer Generated Entirely In-House
Paid for by Ricardo Lara for Senate 2012, 550 S. Hope St., Suite 1910, Los Angeles, CA 90071