Contribution
Theresa Lott for Mayor

408 Highway 76 East PMB # 113

White House, TN 37188

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name of employer of individuals whose contributions exceed $200 in a calendar year.

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City:

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Telephone:

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Please make checks payable to:
Theresa Lott For Mayor - Jeana Ball Treasurer

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I am 18 years of age or older; I am a U.S. citizen or have permanent resident status in the U.S.; I have made this contribution solely from my own personal funds and not from the funds of any business entity or labor organization.

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Contributions to Theresa Lott For Mayor - Jeana Ball Treasurer are subject to the prohibitions and limitations of the Federal Election Campaign Act. That law prohibits contributions from corporations, labor unions, national banks, government contractors and foreign nationals who are not admitted for permanent residence. All contributions must be made from personal funds and may not be reimbursed by any other person. Contributions to Theresa Lott For Mayor - Jeana Ball Treasurer are not tax deductible of federal income tax purposes.

www.lottformayor.com | Email: theresa@lottformayor.com | 615.672.4454
408 Highway 76 East PMB # 113, White House, TN 37188