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.
I certify that as the individual contributor, I have provided my residential address, employer and principal occupation.
I certify that I am NOT a principal of a state contractor or prospective state contractor. (If you're uncertain of these terms click this link for definitions: http://tinyurl.com/zohvbjt).
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 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; the name on the card is the name provided above, payment on this card is not made from the funds of a corporation, labor organization or any other entity.
I certify that this contribution is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution.