Zenobia McNally Contribution Card

 Personal Check    Money Order     Cash      $ 

Name

Home Address

City/State/ZIP

To comply with Campaign Finance Reporting rules, please complete the following information:

Employer

Business Address

City/State/ZIP

Occupation

I understand that NY State law requires that a contribution be in my name and be from my own funds.  I hereby affirm that this contribution is being made from my personal funds, is not being reimbursed in any manner, and is not being made as a loan.  My contribution is NOT tax deductible.  NY State law prohibits making a contribution in someone else’s name, reimbursing someone for a contribution made in your name, being reimbursed for a contribution made in your name, or claiming to have made a contribution when a loan is made.

Contributor’s Signature

Date of Contribution