I hereby certify that I am NOT a: a) communicator lobbyist b) spouse or dependent child of a communicator lobbyist, c) principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services d) principal of a state contractor or prospective state contractor, or, if e) I am a principal of a state contractor or prospective state contractor, I am not also an elected public official. 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 either a United States citizen or a foreign national with permanent resident status in the United States. 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.

I agree with the terms and conditions.

Contributions to Wilton Republican Town Committee are not tax deductible for federal income tax purposes. Contributions from corporations, labor unions, federal contractors, and foreign nationals are prohibited.

Mail: To contribute by mail, please send a personal check made payable to “Wilton Republican Town Committee” to:

Wilton Republican Town Committee
P.O. Box 301
Wilton, CT 06897

Please include your full name, address, email address, occupation and employer in the envelope.

PAID FOR BY WILTON REPUBLICAN TOWN COMMITTEE