Washington Democratic Town Committee

*Please review your contact and residential information to ensure it is accurate before submitting your contribution.

The maximum amount an individual may contribute

to this Committee is $2,000 per calendar year.

The annual limit for persons under the age of 18 is $30.

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If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide the Name of Business. (Example: Dave’s Painting.) If self-employed, Provide Job Description. (Example: Painter.)

Are you 18 years of age or older?*

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

Are you or your spouse or dependent child a principal of a state contractor or prospective state contractor? If yes, please indicate which branch or branches of government the contract(s) is with:*

Are you an elected public official?*

Are you a principal of a holder of a valid prequalification issued by the Commissioner of Administrative Services?*

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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 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.

I hereby certify that the address used in this contribution is my residential address.

I hereby certify that the name used in this contributor form is the name that appears on the credit card used for this contribution.

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