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LeonardRiggioandWilliamLynchIII
and
Hon.DavidN.Dinkins
cordiallyinviteyoutoaneventinsupportof
BilldeBlasioCandidateforMayorofNYC
Monday,October28th,2013
8:30am10:00am
SylviasAlso328LenoxAvenue(btw126thand127thStreets)
NewYork,NY
ContributionLevels:Co-Chairs:Raise$10,000HostComittee:$4950Supporter:$1000Guest:$500
Personalcontributionsonly.Corporate,LLC,andLLPcontributionsarestrictlyprohibited.
Pleasemakecheckspayableto:NewYorkersfordeBlasio
Sothatwemayplanaccordingly,pleaseRSVPtoElanaLeopoldbyemail:[email protected]:(646)361-2530
PaidforbyNewYorkersfordeBlasio
7/27/2019 DinkinsRiggioLynchBDB.pdf
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FundraisingReceptionforBilldeBlasio
Monday,October28th,20138:30am10:00am
Yes! I would like to attend the breakfast on October 28th, and I
would like to contribute$_____________________
No, I cannot attend the event on October 28th, but I would still
like to support Bill and contribute $__________
Name: __________________________________ Home Address:
____________________________________________________
City: __________________ State: ______________ Zip Code:
__________ Contribution Amount: $ _________________
Your Employers Name: ____________________________ Your
Occupation: _____________________________________
Your Work Address: _________________________________City:
_______________ State: _______ Zip Code: _________
Home Phone: ____________________ Work Phone:
______________________ Cell Phone:_______________________
Fax: _______________________ E-mail address:
_____________________________________________
Please indicate if contribution is being made by: Cash_______
Money Order________ Credit Card______ Check______
Please charge my: ___Visa ___MasterCard ___AMEXCredit Card
No:_________________________________________ Exp. Date: _______
Please make checks payable to:New Yorkers for De Blasio- and
mail toNew Yorkers for De Blasio32 Court Street, Suite 902Brooklyn,
NY 11201
*For contributions of more than $400 only: Please complete Doing
Business questionnaire.
Please indicate whether you have business dealings with the
City: YES ______ NO_______ NOT SURE______ (If yes, please complete
section below):
City Agency/Agencies Name and Address of
Doing Business Entity
Business Category
(for example, Contracts)
Relationships
(for example, CEO)
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 contributio
is being made from my personal funds, is not being reimbursed in
any manner, and is not being made as a loan.Credit Card
Contributors: I affirm that this contribution is being made from my
personal credit card account, billed to and paid b
me for my personal use and having no corporate and business
affiliation, and is not being made as a loan.
Your signature required:
_________________________________________ Date Signed:
________________________
Contribution Requirements: We cannot accept: contributions from
corporations, partnerships or limited liability companies (LLCs);
cash contributions that are more than $100
any contributions over $4950. *If a contributor has business
dealings with the City as defined in the Campaign Finance Act, the
contributiolimit is $400.
Federal law prohibits contributions from foreign nationals. We
cannot accept contributions from political committees, unless the
committee registers with the Campaign Finance Board. If you wish to
make
contribution from an unregistered committee, call Elana
646-361-2530 for a registration form.
Contributions are not tax deductible.State law prohibits making
a contribution in someone elses name, reimbursing someone for a
contribution made in your name, bein
reimbursed for a contribution made in your name, or claiming to
have made a contribution when a loan is made
Paid for by New Yorkers for de Blasio. Printed in house.
