By making a donation, I hereby certify that I have read and understand the applicable definitions listed below and state all of the information disclosed by me and set forth above is true and accurate to the best of my knowledge and belief.

1. I certify that I am NOT a principal of a state contractor or prospective state contractor.

2. I certify that I am either a United States citizen or a foreign national with permanent
   resident status in the United States.

3. I certify that I have provided my residential address.

4. I certify that this contribution is made on my personal debit or credit card for which I
   have a legal obligation to pay and intend to pay from my own personal funds, is not
   being reimbursed in any manner, is not being made as a loan, is not an otherwise
   prohibited contribution, and that payment on this card is not made from the funds of a
   corporation, labor organization or any other entity.

5. I hereby certify that all of the information disclosed by me on this contributor form is
   true and accurate to the best of my knowledge and belief.

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