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Donate – Form

Citizens’ Election Program Qualifying Contribution Form

Boucher for CT

The Campaign requests that the contributor complete the entire certification form.



Participating candidates may not accept contributions from an individual who is a principal of a state contractor or prospective state contractor or from a minor who is under 12 years of age. Under Public Act 2010-01, participating candidates may accept qualifying contributions from individuals who are communicator lobbyists or their immediate family members. Disclosure of lobbyist status remains a legal requirement pursuant to General Statutes § 9-608 (c) (1) (H). Maximum $100 limit per donor ($30 limit if age 12-18).

Notes:
Name of Employer: If self-employed, provide Name of Business. Example: Dave’s Painting. Other examples: Retired, Unemployed, Student, Homemaker. Principal Occupation: If self-employed, provide job description. Example: Painter. Other examples: Retired, Unemployed, Student, Homemaker

*A sole proprietorship is a business in which one human being owns all the assets, owes all the liabilities, and operates in his or her personal capacity. Any other type of business is not permitted to make a qualifying contribution, including LLCs. See General Statutes §§ 9-601 (9), 9-704.

**You may enter an alternate address in lieu of your residential address only if you are admitted into the Address Confidentiality Program pursuant to General Statutes § 54-240 (a) or if you are one of the individuals with protected address status articulated in General Statutes § 1-217.

Please click here for a definition of terms.