Protect Prop. 13 Committee Mail-in Donation Form

Thank you for contributing to the Protect Prop.13 Committee, a project of the Howard Jarvis Taxpayers Association. Your contribution will help to protect California taxpayers from the rampant tax increases that would become an annual occurrence if we ever lost Proposition 13. Donations to this committee may be used for radio and TV ads, campaign mail, yard signs and all the other efforts that go into a campaign related to ballot measures.

California law requires that we collect the following information from all donors to the committee. Please print and complete this form and send it along with your check to the address below. Thank you!

Donor Information:

Name:__________________________________________

Address:_______________________________________
(P.O. box addresses are not permitted.)

City:_________________ State:____ Zip:_________

Phone:_______________________________(optional)

E-Mail:______________________________(optional)

 If donor is a PAC, provide SOS ID number:
______________________________

 If donor is a business or organization, choose one:

 Corporation

 LLC

 Partnership

 Other: _________________

Name of individual with primary responsibility
for approving this contribution:
__________________________________________

 If donor is an individual, complete the following:

Occupation:____________________________________

Name of Employer:______________________________
(If self-employed, please print name of business in Name of Employer space above. If retired, please print “none.” Thank you.)

INTERMEDIARY: If you are making this contribution on behalf of someone else, either because you are the person’s agent in control of disbursing funds at their direction held in an account under your name or because you are being reimbursed, you are an intermediary. State law requires the following information:

Full Name of Intermediary:__________________________________________

Intermediary’s Street Address (No PO Box):_______________________________________
(P.O. box addresses are not permitted.)

City:_________________ State:____ Zip:_________

 Intermediary is an individual
Occupation:____________________________________
Employer:______________________________________

 Intermediary is a business

Please make your checks payable to “Protect Prop. 13.”

Donation Amount:                     $_________

Thanks again for your support. Every dollar and every vote counts in the fight to protect taxpayers.

Please Mail To:

Protect Prop. 13 Committee
Howard Jarvis Taxpayers Association
621 South Westmoreland Avenue, Suite 200
Los Angeles, CA 90005

* Contributions are not tax deductible for federal income tax purposes.