Friends of Costa Constantinides - Contribution Card

Intermediary: Progressive Caucus Alliance Date: ____________ Amount: _________ ____ Check (Check #: __________) ____ Money Order

Please make out one check per candidate, payable to Friends of Costa Constantinides.

Name__________________________________________________________________________________________________________________ Home Address________________________________________________________________________________________________________ City/State/Zip_________________________________________________________________________________________________________

The following information is for internal purposes only and will not appear in public disclosure filings:

Home# __________________________________ Work #___________________________Cell # ____________________________________ E-Mail__________________________________________________________________City Council District (if known)_____________
To comply with Campaign Finance Rules, please provide the following information:

Employer*_______________________________________________Occupation_________________________________________________ Business Address______________________________________________City/State/Zip________________________________________

*For public disclosure purposes, please indicate if you are retired, a homemaker, a student, or self-employed. The following statement is required by NYC Campaign Finance Board Rules: I understand that 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.

_______________________________________________________Contributors Signature __________________ Date of Contribution

Doing Business Restrictions: If a contributor has business dealings with the City as defined in the Campaign Finance Act, such contributor may contribute only up to $250 for city council, $320 for Borough President, and $400 for mayor, comptroller, or public advocate. If you are doing business with the City, please complete the following (for more information on the doing business rules, see www.nyccfb.info/doingbusiness). City Agency/Agencies Name & Address of Doing Business Entity Business Category (e.g. contracts) Relationship(s) (e.g. CEO) Contribution Requirements: Maximum contribution is $2,750. We cannot accept: contributions from corporations, partnerships, LLCs, political committees, or foreign nationals; cash contributions that are more than $100. Contributions are not tax deductible. Contributions by eligible NYC residents may be matched by as much as 6:1 through the NYC Campaign Finance system. State law prohibits making a contribution in someone elses 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.

Thank you very much! Friends of Costa Constantinides Progressive Caucus Alliance P.O. BOX 150466 Brooklyn, NY 11215