8th District Republican Congressional Committee
Date of contribution: _________________
Please check one:
______ Personal Check
______ Business Check
City: _______________________________ State: __________ Zip: ___________________
Phone: _____________________________ Email: _________________________________
Employer: __________________________ Occupation: ___________________________
Required if amount is over $200.00
Please mail to: 8th District Republican Congressional Committee
1563 Gregory Lane
Jasper, IN 47546
Paid for by the 8th District Republican Congressional Committee www.in8gop.org
Not authorized by any candidate or candidate’s committee.
Contributions to the 8th District Republican Congressional Committee are not tax
deductible for federal income tax purposes. Funds received in response to this solicitation
are subject to state and federal limits. Federal law requires us to use our best efforts to
collect and report the name, mailing address, occupation and name of employer of individuals
whose contributions exceed $200 in a calendar year.
Contributions from foreign nationals are prohibited.