Contributions by Check

            Brian Schmidt for Santa Clara Valley Water District Board 2010 campaign

Please print this page, fill out and mail with your contribution

For reporting purposes, all of the following information is required except email/phone – please fill out completely:

Contribution Amount $35____ $50___ $100___ $250____ $500 (couple)___ Other___

     note: maximum $500 per couple or $250 per person

Name(s)  ____________________________________________________________

Street Address _____________________________________________________

City ________________________________  State________  Zip Code___________

Employer(s)  _________________________  Occupation(s) _______________________

Phone Number (optional) _______________________________

E-mail (optional) ______________________________________

Please make check out to “Brian Schmidt’s campaign"

Mail your contribution to:
Brian Schmidt’s campaign

PO Box 391176

Mountain View, CA 94039

Thank you very much for your support!

Note: Political contributions are not tax deductible for any income purposes.
Donors cannot be reimbursed for their contributions.  FPPC ID #1328260, Karen Coppock, Treasurer