Fred for Connecticut

Thank you for your donation to the Fred for Connecticut campaign.

Maximum Aggregate Contribution Amount is $340.00. Contributions from P.O.Box addresses are not allowed.

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Employer (required information): If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide name of business (Ex: Dave's Painting. Other Ex: retired, unemployed, student, homemaker).*

Principal Occupation (required information): If self-employed, provide job description. (Ex.: painters. Other Ex: retired, unemployed, student, homemaker).*

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: Select*

Are you a communicator lobbyist OR the spouse or dependent child of a communicator lobbyist? (Communication lobbyists cannot make contributions to candidates during the legislative sessions.)*

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Are you a principal of an investment services firm that has received compensation, expenses or fees, or has been issued a contract by the CT State Treasurer? (Principals of such an investment firm cannot make contributions to State Treasurer candidates.)*

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Requirement*

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

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

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

* I certify that I have provided my residential address.

* 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.

* 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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