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If you are retired, please put: Occupation: , Employer:
If you are unemployed, please put: Occupation: Unemployed, Employer: Not employed
If you are a stay-at-home parent, please put: Occupation: Stay-at-home parent, Employer: Not employed
If you are self-employed or an independent contractor and do business under your first and last name, please put: Occupation: <describe your business>, Employer: First and Last Name
If you are self-employed and do business under a business name, please put: Occupation: <describe your business, i.e., "photographer">, Employer: The name that people put on checks to your business, i.e., "Jake's Discount Photography"
If you are employed by a company, please put Occupation: <describe your job title, i.e., "Director of Sales">, Employer: <the name of your employer>.
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I certify the following:
contribution is not being made under a false name, is not being made under
another person’s name, has not been reimbursed, and will not be reimbursed.
? This contribution does not cause me to exceed
my contribution limit of $1,500.00. I understand that all contributions I make to
this candidate or committee must be cumulated.
I understand that a contribution from another individual or entity whose
contribution activity I control, such as a business that I own or control, must
be aggregated with this contribution, and both contributions will be treated as
a single contribution from me.
? I am a United States citizen or a lawfully
admitted permanent resident (i.e.,
green card holder).
? I am not a lobbyist or lobbying firm that is
prohibited from contributing under Los Angeles City Charter § 470(c)(11).
? I am not a bidder, sub-contractor, principal,
or underwriting firm that is prohibited from contributing under Los Angeles
City Charter § 470(c)(12) or 609(e).
I certify under penalty of perjury under the laws of
the City of Los Angeles and the state of California that all of the information
in this contributor certification is true and correct.
Total donation amount may not exceed $1500.00
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