Invitation and Contribution Form - Deputy Sheriffs' Association of ...

Please join the Board of DirectorsOf the Deputy Sheriffs Association of San Diego CountyErnie Carrillo, President*Ponzio Oliverio, Vice President*Matthew Clay, Secretary/Treasurer*Matthew Etchepare, Director*Tim Petrachek, Director*Steve Purvis, Director*For a fundraising reception honoringJim DuffyCandidate for SheriffWednesday, December 9, 20096:00pm VIP Reception / $200 Per Person6:30pm General Reception / $100 Per Person for Friends of DSA$50 Per Person for DSA MembersContribution Form AttachedAt The Offices of The Deputy Sheriffs Association13881 Danielson Street, Poway, CA 92064Please RSVP your attendance to Lacee Beaulieu at (760) 440-9755or Via email to Laceemb@aol.com.* Titles listed for identification purposes only.

Yes! I support Jim Duffy for Sheriff.__________ I will attend the event on December 9th.__________ I cannot attend the event on December 9th.[ ] Enclosed is my personal contribution, payable to Duffy for Sheriff, in the amount of:[ ] $1,000 per couple (maximum primary donation per couple) [ ] $500 per person (maximum primary donation)[ ] $250 [ ] $100 [ ] $50 [ ] $25 [ ] Other $_____________[ ] To contribute by credit card, please complete the following:Please circle one: Visa MasterCard American ExpressName on Card _______________________________________________________Card Number ________________________________________________________Amount $______________________Exp Date ___________________________________________________________________Signature of Contributor_________________________________________Signature of Spouse (if joint contribution)Please mail or fax this completed form (or address inquiries) to:Duffy for SheriffAttn: Lacee Beaulieu, Post Office Box 371494, San Diego, CA 92137Phone: (760) 440-9755 Fax: (760) 440-9757 Email: LaceeMB@aol.comALL CONTRIBUTORS MUST COMPLETE THE FOLLOWING INFORMATION. WE ARE REQUIRED TO REPORT THE NAME,ADDRESS, OCCUPATION AND EMPLOYER OF ALL CONTRIBUTORS*._______________________________________________________Full Name_______________________________________________________Occupation_______________________________________________________Employer______________________________________________________________Your Spouse’s Name & Signature (Required if Joint Contribution)_______________________________________________________________Spouse’s Occupation (Required if Joint Contribution)_______________________________________________________________Spouse’s Employer (Required if Joint Contribution)_______________________________________________________________________________________________________________________________Your Street Address_____________________________________________________ ___________________________ _______________________________City State Zip Code_______________________________________________________Work Phone_______________________________________________________________Fax_______________________________________________________Home Phone_______________________________________________________________Cell Phone_______________________________________________________________________________________________________________________________E-MailDuffy for Sheriff may only accept contributions from individuals, or professional corporations that include only one individual, up toa maximum of $500 ($1,000 per couple) in the Primary election and again in the General election. Corporate and PACcontributions are prohibited. Contributions are not tax deductible as charitable contributions for federal income tax purposes andcannot be reimbursed. Contributions from foreign nationals without permanent residency status and from county lobbyists areprohibited. Paid for by Duffy for Sheriff 2010, ID # 1306762, 5694 Mission Center Road, Suite 602 – PMB 108, San Diego, CA92108.