Mail Contribution Form
State election law requires the Oklahomans for Anthony
campaign to collect the name, address, occupation, employer and signature of
individuals who contribute.
Contributor Name(s): ___________________________________________________________
Complete Address: ____________________________________________________________
______________________________________________________________________________
Occupation: ________________________
Employer: ___________________________
Contribution Amount: $_______________
(personal checks only)
Date of Contribution: __________________
Declaration Required by State Law:
This contribution is for a campaign in the State of Oklahoma and was freely and voluntarily given by me from my personal property. I have not, directly or indirectly, been compensated or reimbursed for this contribution.
Contributor's
Signature:
X__________________________________________
All the information on this form is required by law. Please note that state law prohibits corporate checks and limits individual campaign contributions to $5,000 per household.
Please print this page. Then return the signed and completed form with your personal check made payable to:
Oklahomans for Anthony
P.O. Box 54598
Oklahoma City, OK 73154
Thank you!
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