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Contributions to the Duane Cutlip for NC House 39 Campaign are not tax deductible as charitable contributions for Federal Income Tax purposes. Contributions from corporations and foreign nationals are not permitted. NC law requires political committees to report the name, address, occupation and employer for each individual whose contribution exceeds $50 in an election cycle. NC law prohibits the solicitation of lobbyists and registered PACs by state legislative candidates during the regular session of the General Assembly. Please disregard this request for funds if you or your organization falls under the prescribed organizations of lobbying activity.

Donor Level: ___ $4000 ___ $2000 ___ $1000 ___ $500 ___ $100 ___ Other ______
Title: _________________________________				First Name:	_____________________
Last Name: ____________________________				Email:	_____________________
Address:	________________________________________________________________
City:	____________________________			County:	______________________
State:	_______	Zipcode:	__________	Phone:	( ____ ) _______________
Employer:	____________________________			Occupation:	______________________
Please submit your personal check with this completed form to: Duane Cutlip for NC House 39 PO Box 1653 Wendell, North Carolina 27591 Thank you for your support!
Contributions to the Duane Cutlip for NC House 39 Campaign are not tax deductible as charitable contributions for Federal Income Tax purposes. Contributions from corporations and foreign nationals are not permitted. NC law requires political committees to report the name, address, occupation and employer for each individual whose contribution exceeds $50 in an election cycle. NC law prohibits the solicitation of lobbyists and registered PACs by state legislative candidates during the regular session of the General Assembly. Please disregard this request for funds if you or your organization falls under the prescribed organizations of lobbying activity.