Old Saybrook Republican Town committee

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This contribution is made knowingly and voluntarily from my own funds, not those of another and the contribution is not controlled by another individual or made from the proceeds of a gift given to provide funds to be contributed.

This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.

I am not a foreign national who lacks permanent resident status in the U.S., nor do I personally contract with the federal government for personal services or the sale of goods, land or buildings.

I am at least 18 years old. • I affirm that this contribution is made on a personal credit card for which I have the legal obligation to pay, and not through a corporate or business entity card or the card of another.

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