Reception to Support Councilwoman Jan Perry for Mayor

Carmelita Pittman

Deborah Bradley * Jackie Hawthorne * Celestine Palmer

Cordially Invite You To A Grassroots Fundraiser To Support

Los Angeles City Councilwoman

Jan Perry

FOR

Mayor

Saturday February 23, 2013

4:00pm to 6:00pm

The Home of Gloria Berlin

Celebrity Realtor/Author

6524 Petit Ave

Lake Balboa, CA 91406

Please RSVP By Friday, February 22nd To 323-574-1464 or 310-274-1130

$25

Paid For By Jan Perry for Mayor 2013

Additional information is available at ethics.lacity.org

PRINTED IN-HOUSE

Jan Perry for Mayor February 23rd Event

Thank you for agreeing to give/raise $______. ($1,300 maximum per person or entity.)

** Up to the first $500 of your contribution made by personal check or credit card will be matched 200%**

Please have your check made out to Jan Perry for Mayor 2013 and return it with the completed form below to:

Jan Perry for Mayor 2013

1531 Purdue Avenue

Los Angeles, CA 90025

Please mail your check today, or fax this form to 310-473-9465.

The City Ethics Commission requires us to obtain your occupation, employer, and physical address before depositing your check.

ID# 1337352

Name______

Occupation______Employer______

If Self-Employed, Name of Business:______

Address______Ste. No.______

City______State______Zip Code______

Work Phone (___)______Home Phone (___)______

Fax:______Email:______

Or pay by credit card:

Card Number:______Exp Date.______

Amount:______Name on Card:______

Billing Address:______

Signature:______

Please check if this is a personal ______or business______credit card.

The City Ethics Commission requires you to acknowledge and sign below:

I confirm that the following statements are true and accurate:

• I am not a foreign national who lacks permanent residence in the United States.

• The contribution has not been and will not be reimbursed.

• The contribution is not being made under another person’s name, unless I am acting as an intermediary and have provided that person’s name, street address, occupation and employer information.

• The contribution is not being made under a name other than the name by which the contributor is identified for legal purposes.

• The contribution does not exceed my aggregate contribution limit in Charter Section 470(c)(6) which is $9500 for the March 2013 primary election.

• The contribution is not from a lobbyist or lobbying firm that is prohibited from contributing under Charter Section 470(c)(11).

• The contribution is not from a bidder, sub-contractor, principal, or underwriting firm that is prohibited from contributing under Charter Section 470(c)(12) or Charter Section 609(e).

Signature______Date______

Paid for by Jan Perry for Mayor 2013, 1531 Purdue Ave, Los Angeles, CA 90025. Additional information is available at ethics.lacity.org. Contributions are not tax deductible for income tax purposes. The maximum legal contribution is $1,300 per individual, business, labor union, or PAC. An individual contribution will be aggregated with a business contribution if the individual owns 50% or more of the business OR controls or directs contributions from the business. Two businesses with substantially similar boards, owners, officeholders or majority shareholders, as well as two businesses that have a parent-subsidiary relationship, will be aggregated under one $1,300 limit. Couples may give $2,600 from common funds if they both sign the check. L.A. city lobbyists may not contribute. Contributions must be from the donor’s own funds and not reimbursed by any other person. ID#1337352.

Computer generated, laser printed.