Torres for Assembly 2012

Make checks payable to:
Torres for Assembly 2012 - FPPC ID No. 1333864

Mail to: 1127 11th Street, Suite 505, Sacramento, CA 95814
(Please note: New contact name and address.)

Donor (please print):_____________________________________________________________

Employer:_________________________________________Occupation:__________________
(if self-employed, name of business

Street address:__________________________________________________________________

City:_________________________________________State:_________Zip:________________

Day phone:_________________________ Cell phone:_________________________________

Fax:_________________________Email:____________________________________________

Contribution amount: $_____________ Please charge my: AMEX MC VISA

Credit card #:_____________________________________________Exp. Date:_____________

Name as it appears on credit card:__________________________________________________

Signature:_____________________________________________________________________

Billing Address (if different from above):____________________________________________
Contributions to these committees are not deductible for federal income tax purposes. The Ca. Political Reform Act (Prop. 34) places limits on contributions (including loans) to candidates for state office and imposes certain prohibitions. This request does not seek a contribution in excess of applicable limits or from prohibited sources. The committee may accept contributions from only U.S. citizens or permanent residents. An individual, union, PAC, partnership, business, or corporation may contribute a maximum of $3,900 per election, primary and general.
A registered Small Contributor Committee may contribute a maximum of $7,800 per election.
Laser printed. Authorized by Torres for Assembly 2012.

For more information contact: Connie Sanders Emerson at conniesandersemerson@earthlink.net