OFFICIAL USE ONLY
Registration Verified
District Verified (If Applicable)

Nonrefundable Contribution of $5 only, is made from my funds to qualify the above named candidate. I will not be compensated in any way for this contribution. I am registered to vote in the city of Santa Fe.

Name of Contributor (As appears on Voter Registration) (Please Print)

Address of Contributor (As appears on Voter Registration -- No P.O. Box) (Please Print)

#	 Council District
(If Applicable)

Telephone Number of Contributor

Signature of Contributor

 	/	/	
Date of Contribution

Amount Contributed

$5.00

City Councilor Candidates shall only receive qualifying contributions from qualified electors registered to vote in the city council district in which the candidate is running.

OFFICIAL USE ONLY
Registration Verified
District Verified (If Applicable)

Nonrefundable Contribution of $5 only, is made from my funds to qualify the above named candidate. I will not be compensated in any way for this contribution. I am registered to vote in the city of Santa Fe.

Name of Contributor (As appears on Voter Registration) (Please Print)

Address of Contributor (As appears on Voter Registration -- No P.O. Box) (Please Print)

#	 Council District
(If Applicable)

Telephone Number of Contributor

Signature of Contributor

 	/	/	
Date of Contribution

Amount Contributed

$5.00

City Councilor Candidates shall only receive qualifying contributions from qualified electors registered to vote in the city council district in which the candidate is running.

City of Santa Fe
Record of Qualifying $5 Contribution

Name of Candidate (please print) 	 Check one:	Mayor	Municipal Judge
City Councilor District # 	

OFFICIAL USE ONLY
Registration Verified
District Verified (If Applicable)

CC073 - 04/2019

Nonrefundable Contribution of $5 only, is made from my funds to qualify the above named candidate. I will not be compensated in any way for this contribution. I am registered to vote in the city of Santa Fe.

Name of Contributor (As appears on Voter Registration) (Please Print)

Address of Contributor (As appears on Voter Registration -- No P.O. Box) (Please Print)

#	 Council District
(If Applicable)

Telephone Number of Contributor

Signature of Contributor

 	/	/	
Date of Contribution

Amount Contributed

$5.00

City Councilor Candidates shall only receive qualifying contributions from qualified electors registered to vote in the city council district in which the candidate is running.

OFFICIAL USE ONLY
Registration Verified
District Verified (If Applicable)

CC073 - 04/2019

Nonrefundable Contribution of $5 only, is made from my funds to qualify the above named candidate. I will not be compensated in any way for this contribution. I am registered to vote in the city of Santa Fe.

Name of Contributor (As appears on Voter Registration) (Please Print)

Address of Contributor (As appears on Voter Registration -- No P.O. Box) (Please Print)

#	 Council District
(If Applicable)

Telephone Number of Contributor

Signature of Contributor

 	/	/	
Date of Contribution

Amount Contributed

$5.00

City Councilor Candidates shall only receive qualifying contributions from qualified electors registered to vote in the city council district in which the candidate is running.

City of Santa Fe
Record of Qualifying $5 Contribution

Name of Candidate (please print) 	 Check one:	Mayor	Municipal Judge
City Councilor District #