Page 8 - Kern

Jerry Kern for Supervisor 2018

I would like to make a contribution to Jerry's campaign of:

$1,600 (per couple) $800 $500 $250 $100 Other _____________

By submitting this form you hereby confirm that the following statement is true and accurate: I am a United States citizen or
a permanent resident alien.

Full Name Spouse Name

Address

City State Zip

Email
Bus Phone Cell Phone

Occupation Employer

Spouse Occupation Spouse Employer

Signature Spouse Signature

Please make checks payable to Mailing Address

Kern for Supervisor 2018 Kern for Supervisor 2018
C/O Lacee Beaulieu & Associates
P.O. Box 503930
San Diego, CA 92150-3930

For information please call: Lacee Beaulieu at 619-339-1191 or you may email forms to LaceeMB@aol.com.

Credit Card Contribution Information Please charge: $__________________

Name as it appears on card:
Card Number

Expiration Security Number
Billing address (if
different than above)

Political contributions are not tax deductible. County law permits only personal checks and limits contributions to $800 per
individual, $1,600 per couple per election. Spouses may write separate checks or write one check signed by both spouses if
the check exceeds $800. For credit card transactions, individual contributions must be made using his or her own individual
credit card. You may not use the same credit card for two contributions, such as a husband and wife. Contributions from any
registered lobbyist with the County of San Diego are prohibited. State law prohibits reimbursing donors for their contribution.
Paid for by Jerry Kern for Supervisor 2018, FPPC #1388472