Nikki's Birthday Bash!

Country

Street address

Apt, suite, etc.

City

State

Zip code

Street address

Apt, suite, etc.

City

Province

Postal code

Street address

Apt, suite, etc.

City/Suburb

Postal code

State/territory

Street address

Apt, suite, etc.

City

Postal code

Building number and street name

Address 2

City

Postcode

Street and building number

Apt, suite, etc.

Postal code

City

Province

Street address

Apartment, suite, etc.

Postal code

City

Street and building number

Apt, suite, etc.

Postal code

City

Street address

Apt, suite, etc.

Postal code

City

State/region

Law requires we ask for your employer and occupation. If you do not have an employer or are retired, check “I do not have an employer”. If you are self-employed put “self-employed” in employer and describe your occupation.

Contribution rules

- Contributions are not tax deductible for Federal or California income tax purposes. In making this contribution, the contributor affirms that they are a U.S. citizen or a permanent resident. If this contribution would cause the total contributions given to this committee to exceed $500, the contributor affirms that they are not currently a party, participant, or a party or participant’s agent with a proceeding involving a license, permit, or other entitlement for use either pending before Alameda County or has received a final decision from Alameda County in the last 12 months. If at a later date the donor meets the above requirement, they agree to notify the candidate, as required by law. The Alameda County Campaign Reform Ordinance limits campaign contributions to a maximum of $20,000 per donor per election cycle (AC 1.07.030).

I confirm that the above statements are true and accurate.

$ 100.00

Nikki's Birthday Bash!

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