sadfasdfadsf

1. STATE OF ARIZONA - $5.00 CANDIDATE QUALIFYING CONTRIBUTION FORM
Under Clean Elections laws, $5.00 contributions can only come from Arizona registered voters. Any Arizona
registered voter may contribute, regardless of party affiliation. Please help by making a $5.00 contribution.
INSTRUCTIONS
• Contributions may be in the form of a check or in cash, and must be exactly $5.00.
• Checks must be made payable to Parker Exploratory Committee.
• One contribution form per Arizona registered voter.
• This form must remain whole. It may be photocopied, but cannot be altered in any other way.
• All contribution and forms should be returned to 6619 N. Scottsdale Rd., Building D, Scottsdale, Arizona 85250
• A $10.00 check is acceptable from a couple provided both names appear on the account and both parties
have signed the check. Each person still must fill out an individual form!
CANDIDATE’S NAME: VERNON PARKER OFFICE SOUGHT: GOVERNOR
CONTRIBUTOR INFORMATION
CONTRIBUTOR’S NAME (Please Print) ____________________________________________________
STREET___________________________________________________ CITY ____________________ ZIP _________________
N/A
COUNTY _________________________________ LEG. DIST.____________ FAX ____________________________________
EMAIL _______________________________________________________ PHONE ___________________________________
______________________________________ ___________________________
SIGNATURE OF CONTRIBUTOR DATE OF CONTRIBUTION
SOLICITOR INFORMATION
SOLICITOR’S NAME
STREET CITY ZIP COUNTY Maricopa
I, the undersigned, upon my oath and under penalty of perjury, certify that I received a $5.00 contribution from the above contributor,
who is to the best of my information and knowledge, a qualified elector of this state.
SIGNATURE OF SOLICITOR: ____________________________________________________
Please keep a copy and return signed and dated original to 6619 N. Scottsdale Rd., Building D, Scottsdale, AZ 85250
PAID FOR BY PARKER EXPLORATORY COMMITTEE
www.parker2010.com info@parker2010.com