Carolyn Maimone-Dillon Campaign Contribution Form

Elect

Maimone-Dillon

Water Authority District 3

Contribution Form

Thank you for supporting the Carolyn Maimone-Dillon Campaign for

Lake County Water Authority District 3

Please fill out this form and send it with your contribution check.

Make Checks Payable to:

Carolyn Maimone-Dillon Campaign

27938 Tammi Drive

Tavares, FL 32778

Name of Individual or Business: ___________________________________

Street Address: ________________________________________________

City: _____________________ State: __________ Zip: _______________

Phone Number: _______________________________________________

Occupation: __________________________________________________

Email Address: ________________________________________________

Contribution Amount: $500 $250 $100 $50 Other: ___________

May we add your name to our List of Endorsements: Yes No

· There is a $500 Maximum Donation per person or business

· You must be 18 years of age or older to donate over $100

· Cash contributions cannot exceed $50

· Campaign contributions are not tax-deductible.

· Anonymous donations cannot be used and will be donated to the charity of the candidates choosing at the end of the election.

Lake County

WATER AUTHORITY

Political advertisement paid for and approved by Carolyn Maimone-Dillon, Republican for Lake County Water Authority, District 3