Vicki for Trumbull

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Email*

Phone*

First name*

Last name*

Residential Address*

Apt, Unit, etc.

City*

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Postal Code*

Employer*

Please note: If self-employed, provided Name of Business, Examples: Dave's Painting, Retired, Unemployed, Student, Homemaker.

Principal Occupation*

Please note: If self-employed, provide Job Description. Examples: Painter, Retired, Unemployed, Student, Homemaker.

Are you 18 years or older?*

Are you a lobbyist?*

Are you the spouse or dependent child of a lobbyist?*

Do you or a business with which you are associated have a contract with the town, city, or borough in which the candidate is running that is valued at more than $5,000?*

Requirement*I hereby certify and state that all of the information disclosed by me and set forth above on this contributor form 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 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.  <a href="https://seec.ct.gov/Portal/data/forms/SampleForms/DefinitionsofTermsMunicipalCandidates.pdf" rel="noopener noreferrer" target="_blank" style="color: rgb(0, 102, 204);">Click here to read legal definitions. </a>