I hereby certify and state that all of the information disclosed by me and set forth above on this contributor card is true and accurate to the best of my knowledge and belief.
I certify that I am 18 years of age or older.
I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States.
This contribution is made on my
card for which I have a legal obligation to pay and
intend to pay from my own personal funds; payment on this card is not
made from the funds of a corporation, labor organization or any other
I certify that this contribution is being made from my personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.