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Bobby DuBose for Ft Lauderdale City Commission District 3 P.O. Box 1041 Ft Lauderdale, FL 33311

Name               ___________________________________

Address           ___________________________________

City                 ___________________________________

State                ___________________________________

Zip                   ___________________________________

Phone              ___________________________________

Email               ___________________________________

Employer         ___________________________________

Occupation      ___________________________________

Please Sign Below:

Enclosed is a check for $_____________made payable to Bobby DuBose Campaign.  I am making my contribution to Bobby DuBose Campaign.  I am making this contribution with my own personal funds and not with funds provided by any other person.

Signature                  __________________________________________________

Contributions are not deductible as charitable contributions for federal income tax purposes. Florida Election Law requires us to report the name, address, occupation, and employer for contributions aggregating in excess of $100 in an election cycle. The maximum a natural person may contribute is $250 for the primary election and an additional $250 for the general election. A "Natural Person" shall mean any human being other than an unemancipated child under the age of eighteen.  No contribution will be accepted from a corporation, association, firm, partnership, joint venture, joint stock company, club, organization, estate, trust, business trust, syndicate or other combination of individuals having collective capacity.