Individual Contributor Certification Form

    The Sherman Democratic Town Committee is grateful for your contribution. Thank you for providing the information which we are required to collect.

    To comply with election law, we must ask the following.

    Are you a communicator lobbyist*?YesNo

    Are you the spouse or dependent child of a communicator lobbyist? YesNo

    Are you an elected public official? YesNo

    Are you a principal of a state contractor or prospective state contractor? YesNo

    Please indicate which branch or branches of government the contract(s) is with: ExecutiveLegislative
    Are you an elected public official?YesNo

    Are you a principal of a holder of a valid pre-qualification issued by the Commissioner of Administrative Services? YesNo

    *Click here for definitions

    1. I Am A United States Citizen Or A Permanent Resident Alien Currently Residing In The U.S.
    2. This Contribution Is Made From My Own Funds, Not Those Of Another, Is Not Being Reimbursed In Any Manner, Is Not Being Made As A Loan, And Is Not An Otherwise Prohibited Contribution.
    3. This Contribution Is Made On A Personal Credit Card Or Debit Card For Which I Have The Legal Obligation To Pay, And Is Not Made Either On A Corporate Or Business Entity Card Or On The Card Of Another Person.
    5. I Am At Least Eighteen Years Old.

    Please Check This Box To Certify That All The Information Provided Above Is True And Accurate.