Federal election law requires political committees to use best efforts to report the name, mailing address, occupation, and name of employer of individuals who contributions exceed $200 during an election cycle.
By submitting this form, I certify that:
This contribution is made from my own funds and will not be reimbursed by any other person or entity;
This contribution is not made from the treasury funds of a corporation, labor union, or national bank or from any person or entity who is a federal contractor;
I am a U.S. citizen or lawfully admitted permanent U.S. resident.
Contributions to Committee to Elect Hageman for Governor are not deductible as charitable contributions for federal income tax purposes.