Political Contribution Voucher - www.hundreddollarparty.org   *Name:__________________________________registered as_______________________ *Mailing address:___________________________________________________________ *Occupation______________ *Employer_________________Contribution $____________ *Required information if survey is sent with contribution I intend to: ( ) vote for ( ) contribute $_________in amounts of $_________ to ( ) parties ( ) candidates ( )_____________________________  name of party or candidate ( ) that only accept contributions from individuals in the amount of $_______ or less ( ) that only accept contributions from individuals and public financing ( ) that do not accept public financing ( ) that support separate voting for parties and candidates ( ) other_______________________________________________________________________ ( ) other_______________________________________________________________________ ( ) other_______________________________________________________________________ ( ) in the 2006 election  ( ) 2007 election ( for state elections in 2007 ) ( ) in the 2008 election  ( ) 2009 election ( for state elections in 2009 ) ( ) in all future elections In previous elections I voted: ( ) for Democrats ( ) 2004 ( ) 2002  ( )___________ ( ) for Republicans ( ) 2004 ( ) 2002  ( )___________ ( ) some of both ( ) 2004 ( ) 2002  ( )___________ ( ) third party__________________ ( ) 2004 ( ) 2002  ( )___________ ( ) independent________________ ( ) 2004 ( ) 2002  ( )___________ ( ) didn't vote ( ) 2004 ( ) 2002  ( )___________ Copies sent to: ______________________________________________________________________________   parties/ candidates ______________________________________________________________________________   newspapers/ magazines ______________________________________________________________________________   TV/ radio programs   Make Check Payable to: Hundred Dollar Party National Committee Mail to: Hundred Dollar Party, PMB # 111, 1465 Route 23 South, Wayne, NJ 07470 Federal law requires political committees to report and use their best effort to collect the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of two hundred dollars in a calendar year. 104.7 (a)(1). 104.7 (b)(1). Contributions will be used in connection with federal elections and are subject to the limits and prohibitions of the Federal Election Campaign Act 102.5(a)(2)(ii)and(iii) Section 6113 of the Internal Revenue Code requires political committees whose gross annual receipts normally exceed $100,000 to include a special notice on solicitations informing solicitees that their contributions are not tax deductible.