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EMPLOYMENT INFORMATION

To comply with the Office of Campaign Finance reporting requirements, please provide your employment information. If you are not employed, indicate what best describes your employment status (e.g.“homemaker”, “retired”, “student”, or “unemployed”). If self-employed, indicate the employer as “self” and provide your occupation and employment address.

AFFIRMATION OF CONTRIBUTOR

I certify and affirm that the contribution is being made in my name and from my own funds. I hereby affirm that I was not, nor, to my knowledge, was anyone else, reimbursed in any manner for this contribution; that this contribution is not being made as a loan; and that this contribution is being made from my personal funds or my personal account, which has no corporate or business affiliation. I am either a District of Columbia resident individual making a small-dollar contribution or a non-District of Columbia resident individual. I understand that making a false statement is a violation of law.

SUBMISSION OF LATE, FALSE, ERRONEOUS, OR INCOMPLETE INFORMATION MAY SUBJECT THE

PERSON TO THE PENALTIES OF D.C. OFFICIAL CODE 1-1163.35

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