I Certify the Following:
• This contribution is not being made under a false name, is not being made under another person’s
name and has not been and will not be reimbursed.
• I am a United States citizen or a lawfully admitted permanent resident (i.e., green card holder)
• I certify under penalty of perjury under the laws of the County of Los Angeles and the State of California
that all of the information above is true and correct.