Ann Kimbrough for DeKalb CEO

EMPLOYMENT INFORMATION

First Name: *     Last Name: *

Employer: *    Occupation: *

Amount to be Donated: $ * (limit $2,300 per individual per election cycle)

ELIGIBILITY

* I confirm that the following statements are true and accurate:

• I am not a foreign national who lacks permanent residence in the United States.
• I am not a Federal government contractor.
• This contribution is made from my own funds, and not those of another.
• This contribution is not made from the funds of a corporation or labor organization.
• 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.
• I am at least eighteen years old.