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Enclosed is my donation of:
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[ ] $25
[ ] $50 [ ]
$100 [ ]
$200 [ ]
$300 Other $_______ |
Please make check payable to "Jim Provenza
for Yolo County Supervisor" (CA Secretary of State ID #1299174).
Name:________________________________________________________________
Address:______________________________________________________________
City:__________________________________
State:_________ Zip: _____________
Home Phone:________________________ Work
Phone:_______________________
(Contributor's occupation & employer
information required by law)
Occupation:_______________________
Employer:___________________________
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