CANDIDATE NAME:Barbara McGuire

OFFICE SOUGHT: State Representative LD23

CONTRIBUTOR INFORMATION

*The contributor informaton must match your voter registration information


Contributors Name: ____________________________________

Voter Registration Address:____________________________

City: ________________________________ State: Arizona Zip:__________________

Home Phone: __________________________ Cell Phone: __________________________

E-mail Address: __________________________________

Signature of Contributor: __________________________ Date: ____________________


SOLICITOR INFORMATION


Solicitors Name: ________________________________

Solicitors Address: ______________________________

City: __________________________ State: Arizona Zip: ____________ County: _________________

Signature of Solicitor: _______________________ Date: _____________________

(I, the undersigned, under oath and under penalty and perjury, certify that I received a $5 contribution from

the above contributor who is to the best of my information and knowledge, a qualified elector of this state.)


PAYMENT INFORMATION

Please send a $5 personal check (payable to: Committee to elect Barbara McGuire 2010 or $5 cash to: P.O. Box 613 Kearny, AZ. 85137


A couple may send a $10 check along with two forms if both names/signatures are on the check.

Contributions are not tax deductable.


*PLEASE RETURN THIS FORM WITH YOUR CONTRIBUTION*

Paid for by the Committee to Elect Barbara McGuire 2010