Informed Voters/Federal Donor
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Please make checks payable to: Informed Voters of Michigan Federal Committee
(Corporate Checks Not Accepted)
Donor Information
Name_________________________________________________________________
Address_______________________________________________________________
City/State/Zip___________________________________________________________
Phone (
)_________________________Email_______________________________
Employment Information
Federal law requires us to use our best efforts to collect and report the name,
mailing address, occupation and employer for individuals whose contributions
exceed $200 in a calendar year. To help Informed Voters comply with this
law, please provide the following information:
Employer's Name____________________________________________
Occupation_________________________________________________
Informed Voters can accept individual contributions of up to $5,000 per calendar
year to our federal account.
Eligibility
In order to comply with Federal Election Commission requirements, we must
confirm that the following statements are true and accurate. Please check
the box of each statement that applies to you. Your contribution cannot
be accepted unless each box is checked.
This contribution is made from my own funds and not from those of
another.
This contribution is not made
from the general treasury funds of a corporation, labor organization or national
bank.
I am not a federal government contractor, nor am I am foreign
national who lacks permanent resident status in the United States.
Contributions to Informed Voters are not deductible for federal income tax
purposes.
Thank you for your support!
Contributions may be mailed with this form to:
Informed Voters of Michigan, PAC
P.O. Box 43499
Detroit, Michigan 48243