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Donor's age? Is the above address your Residence? No PO Boxes are allowed. Residential address if different from above - Street, City State & Zip Is contribution being made from the account of a sole proprietorship?* If yes, and name is different than individual , list NAME OF SOLE PROPRIETORSHIP or DBA Are you a principal of a state contractor or prospective state contractor? If yes, please indicate which branch or branches of government the contract(s) is with: Are you a communicator lobbyist, OR the spouse or dependent child of a communicator lobbyist? Is your Billing Address & Your Residential Adress the same? Billing Address if Different from Residential Address - Street, City, State

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o I hereby certify 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.

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