1. Please make payable to:

“Committee for Kassandra Gove”

Mail to:

9 Gardner Street
Amesbury, MA 01913

Donation Disclaimers

I certify that I am:

1. At least eighteen years of age.
2. Making this contribution with my own funds, and funds are not being provided to me by another person or entity for the purpose of making the contribution.
3. A U.S. citizen or lawfully admitted permanent resident of the United States (i.e., green card holder).
4. Responsible for paying all charges incurred in using the debit or credit card to be charged, and that my personal funds will be the true source of the contribution.
5. Making this contribution with my own personal credit card and not with a corporate or business credit card or a card issued to another person.

Contribution Rules

1. To comply with Federal law, we must obtain the name, mailing address, occupation and name of employer of individuals donating.
2. If you don’t have an employer or are retired, indicate that you are self-employed if “self-employed” and/or retired note retired in employer and describe your occupation.
3. Political contributions are not deductible as charitable contributions for Federal income tax purposes. I certify that I am