9. Principal Occupation _____________________________________________________
I understand that Connecticut law requires that a contribution be in my name and be from my own funds. I hereby affirm that this contribution is being made from my personal funds, is not being reimbursed in any manner,and is not being made as a loan. I further certify that all of the information set forth above on this form is true and accurate to the best of my knowledge and belief.
Contributor's signature Date of contribution
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MAIL YOUR INFORMATION AND DONATION TO:
BEST FOR STRATFORD P.O. Box 663 Stratford, Connecticut 06615
Your contribution is greatly appreciated. Thank you!!!!!