2023 Primary Election Political Contribution

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Durr4Senate

Email *

Date Donation Received *

YYYY

Contributor Type:

Individual

Corporation / Union

Association / Group

Contributor Information

Name: *

Mailing Address Street: *

Mailing Address Town: *

Mailing Address State: *

Mailing Address ZIP Code: *

Phone Number: *

Email Address: *

Occupation: *

If Individual Contribution:

Employers Name:

Employers Mailing Address Street:

Employers Mailing Address Town:

Employers Mailing Address State:

Employers Mailing Address ZIP Code:

Employers Phone Number:

Contribution Amount Information:

Check* ($2,600 Cumulative Maximum Including Cash)

Cash* ($200 Cumulative Maximum)

**If drawn on the account of a partnership, limited liability partnership, or a limited liability company it must be signed by a partner or member who is the contributor**

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