PLEASE PRINT

Name of Contributor

Home Address of Contributor

Telephone Number of Contributor

Contributor’s Occupation

Contributor’s Employer

Amount Contributed $  	

In-Kind Contribution Value $  	

 	
In-Kind Description

Signature of Contributor

 	/	/	
Date of Contribution

City of Santa Fe
Record of Seed Money Contribution

Name of Candidate (please print) 	 Check one:	Mayor	Municipal Judge

PLEASE PRINT

Name of Contributor

Home Address of Contributor

Telephone Number of Contributor

Contributor’s Occupation

Contributor’s Employer

Amount Contributed $  	

In-Kind Contribution Value $  	

In-Kind Description

Signature of Contributor

 	/	/	
Date of Contribution

City Councilor District #  	

City of Santa Fe
Record of Seed Money Contribution

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