You are Cordially Invited to Join Us In Support Of

New York State Attorney General Andrew M. Cuomo
Friday, June 18, 2010 11:30am
The Ft. Orange Club 110 Washington Avenue Albany, NY
Event Chair: $25,000 Table Sponsor: $10,000 Patron: $2,500 Individual Ticket: $750

To RSVP contact Tom Giordano at 212-209-3314 or
Paid for by Andrew Cuomo 2010. Designed in-house.

AndrewCUOMO2010 ● Albany
Church Street Station ● PO Box 683, New York, NY 10008 P (212) 209-3314 ● F (646) 597-6195
YES, I would like to support Andrew Cuomo 2010! I/we have enclosed my/our contribution(s) of:
____$25,000 ____$10,000 _____$5,000 ____$1000 ______$750 ____$2,500

Other $____________


Please charge $_________ on my __________________________________credit card. Card #: ________________________________________________________ Exp. Date: ___________ This card is: ____ Personal ____Corporate ____ Partnership ____ Other Name of Entity/Individual billed ____________________________________________________ Credit card contributions can be faxed to: (646)597-6195
Please fax your response to (646) 597-6195 or call Jennifer Bayer Michaels at (212) 209-3314. For compliance with NYS Election Law, please provide the following information: Name:_______________________________________________________________________________________________ Address:_____________________________________________________________________________________________ Employer/Occupation:__________________________________________________________________________________ To help us better communicate with you, please provide the following: Bus.Phone___________________________________________Email:____________________________________________ Res.Phone___________________________________________Cell:______________________________________________ □ Individual □ Partnership The account being used to make this contribution is registered to and managed by a/an: □ Sole Proprietorship □ PAC or Labor Union □ Candidate Committee □ Corporation □ LLC □ Party Committee

For non-individuals, please provide the contributing entity’s name______________________________________________________ *Contributor’s note to Andrew Cuomo 2010: I notify Andrew Cuomo 2010 that to the best of my knowledge neither I personally nor any entity which I own or control has any matter presently pending with the NYS Attorney General’s office or has had any matter resolved within the last 90 days. Additionally, pursuant to NYS law, I represent that this contribution is from my own funds or from funds of the contributing entity indicated above.

Signature Required:__________________________________________________________________________________
This does not extend to attorneys representing persons or entities with matters before the NYS Attorney General’s office. Contributions to Andrew Cuomo 2010 are not deductible for federal income tax purposes. Andrew Cuomo 2010 accepts no more than $55,900 per election from individuals, unions, political action committees, and trade associations. Partnerships and LLPs that make contributions will be required to specifically identify the partners responsible for the contribution, and that amount will be counted against each partner’s individual contribution limit. Thus, the $55,900 per election limit applies to each partner, individually, and not to the partnership or LLP entity itself. Total contributions from a corporation may not exceed $5,000 per calendar year aggregate to all New York state and local candidate committees. Corporations, other entities and individuals are strictly prohibited from reimbursing another person/entity for making a contribution to Andrew Cuomo 2010. All contributors must be US citizens or permanent resident aliens (green card holder). Not-for-profit corporations pursuant to 501(c)(iii) of the Internal Revenue Code are strictly prohibited from contributing.

Please make checks payable to Andrew Cuomo 2010 and mail to: Church Street Station, PO Box 683, New York, NY 10008. For further information, please contact Jennifer Bayer Michaels at 212-209-3314 or
Paid for by Andrew Cuomo 2010. Designed in-house.

Paid for by Andrew Cuomo 2010. Designed in-house.

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