7/29/2019 Julissa Woolworth Feb 27

1/2

$175 - Friend

$250 - Sponsor

$500 - Host

U n i t e d F e d e r a t i o n o f T e a c h e r s3 2 B J S E I U

&R W D S U

C o r d i a l l y I n v i t e Y o u t o a r e c e p t i o n i n h o n o r o f

N e w Y o r k C i t y C o u n c i l M e m b e r

J u l i s s a F e r r e r a sa t t h e

W o o l w o r t h T o w e r K i t c h e n2 3 3 B r o a d w a y

N e w Y o r k , N Y 1 0 2 7 9

W e d . F e b r u a r y 2 7 , 2 0 1 3

5 : 3 0 p m

R S V P T O :

(347) 201-3634

Or email

Allie

@blissstreetstrategies.

com

T i c k e t s

Julissa 2013

*Contributions are not tax deductible.

Designed in-house. Paid for by Julissa 2013

7/29/2019 Julissa Woolworth Feb 27

2/2

Committee: JULISSA 2013

Please make checks payable to: Julissa 2013Required:

Name: _______________________________________________________________________________________________________

Home Address: _______________________________________City: ___________________________ State: ________ Zip: _________

Your Employers Name: ______________________________________________________________

Work Address: ______________________________________________________________________

City: _______________________________________ State: _______ Zip Code: _________________

Your Occupation: _________________________________________

Contribution Amount: $ ________________

Please indicate if contribution is being made by: Cash_____ Money Order_____ Check______

*If you are doing business with NYC, the contribution limit is $250: A doing business contributor is an owner, principal officer, or seniormanager of an entity or firm that presently does business with the City, or within the past 12 months, has done business with the City or hasbid or applied for business with the City.

The following statement is required by NYC Campaign Finance Board Rules:I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that this contribution is being madefrom my personal funds, is not being reimbursed in any manner, and is not being made as a loan.

*Your signature required: _______________________________________________ Date Signed: ____________________

Please provide the following information so we can contact you, if necessary. This information is for internal purposes only and will notappear in required public disclosure filings:

*Telephone No. (H): __________________________________ Telephone No. (W): ______________________________________

Fax number: ____________________________________ E-mail address: _______________________________________________

Contribution Requirements: We cannot accept: contributions from corporations, partnerships or limited liability companies (LLCs); cash contributions thatare more than $100; any contributions over $2,750. *If a contributor has business dealings with the City as defined in the Campaign Finance Act, thecontribution limit is $250. Federal law prohibits contributions from foreign nationals. We cannot accept contributions from political committees, unless thecommittee registers with the Campaign Finance Board. If you wish to make a contribution from an unregistered committee, call 347-808-8920 for aregistration form. Contributions are not tax deductible.State law prohibits making a contribution in someone elses name, reimbursing someone for a contribution made in your name, being reimbursed for acontribution made in your name, or claiming to have made a contribution when a loan is made.

Checks should be made payable to: Julissa 2013PO Box 608196Corona, NY 11368