Yes! I Want to Donate to Brian L. Gotlieb!

Please complete the form below to donate for Brian L. Gotlieb. The resulting page will need to be printed out and mailed to:
Gotlieb For City Council | 2930 West 5 Street | Suite 12G | Brooklyn, NY 11224
718-996-5668 | 718-946-1302 (fax) | brian@briangotlieb.com
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*$2,750 limit

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*Cash donations may not exceed $100.00.

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I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that this contribution is being made from my personal funds, is not being reimbursed in any manner, and is not being made as a loan.

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1. Contributions from corporations are not permitted.
2. Cash donations may not exceed $100.00.
3. Contributions from individuals who are not US citizens or have not secured their Green Cards are not permitted.
4. Contributions from Political Action Committees (PACs) and other political committees are not permitted unless these organizations have already registered with the NYC Campaign Finance Board.
5. Contributions are not tax deducible.

For Office use only: Date received: __________ CFB Transaction Number: __________