Because this is a political fundraiser, state law requires that we
gather certain information on everyone who makes a contribution. Please print this
letter, clip it off at the line above, answer the questions in advance
and bring it with you to the event. This way you won't be delayed at
the entrance to the event while completing this form. You will not be
allowed admission to the event without providing this information and
purchasing a ticket. The preferred means of contribution is by personal
check made out to "Rocky Hill Democratic Town Committee" (or RHDTC, for
short), but we can accept cash within certain limitations.
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Name: _________________________________________________________

Street address: ___________________________________________________

City/State/Zip: ____________________________________________________

Principal Occupation: _______________________________________________

Name of Employer: _________________________________________________

Check the box if any of these apply to you.

Are you a lobbyist ? [ ]yes [ ]no
Are you the spouse of a lobbyist ? [ ]yes [ ]no
Are you the dependent of a lobbyist ? [ ]yes [ ]no
Do you or the business that you are associated with have a contract
with the state valued at more than $5000.00 ?
[ ]yes [ ]no

Thank you for your cooperation as we strive to keep elections in Rocky
Hill clean.
Rocky Hill Democratic Town Committee, Tony DiLorenzo, treasurer.
http://rockyhill.dems.info/