Silverstein May 2nd FINAL423

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							Silverstein 2013
After Work Party
At                                            Wednesday, May 2 nd
The Irish Rogue
356 W 44th Street                            6:00 pm – 8:00 pm
(btwn. 8th Ave & 9th Ave)



                            Host Committee
       Hon. Stephanie Hausner        Benjamin Kallos
       Hon. Costa Constantinides     Ian Rivera & Brittany Dawn McAllister
       Sarah Jane Arnegger           Matthew McMorrow
       Joe Coe                       Michael J. Murphy
       Jeff Guillot                  Chris Smith
       Seamus Campbell               Daniel Fromm
                                     Jugba Santi



 Tickets:
 Host Committee: $250 ∞ Supporter: $50 ∞ Student: $25

Democratic State Committeeman Matthew Silverstein has decided to open a
2013 New York City Council Exploratory Committee. Please join us for the
Silverstein 2013 Young Professionals After Work Party.

  RSVP:                                           Please Make Checks
  718-473-9828 or                                          Payable to:
  silverstein2013@gmail.com                           Silverstein 2013
                                                          MATTHEW SILVERSTEIN
                                                        Committee: Silverstein 2013
                                               Please make checks payable to: Silverstein 2013
Required:

Name: _______________________________________________________


Home Address: _______________________________________City: _____________ __ State: ________ Zip: _________


Your Employer’s Name: ____________________________ Work Address: ____________________________


City: ___________________________________ State: _______ Zip Code: _________________

Your Occupation: _______________________________________


Contribution Amount: $ ________________

Please indicate if contribution is being made by: Cash__ ___                 Money Order_____             Check______

*If you are doing business with NYC, the contribution limit is $250: A “doing business” contributor is an owner, principal officer, or senior manager of
an entity or firm that presently does business with the City, or within the past 12 months, has done business with the City or has bid or applied for
business with the City.

The following statement is required by NYC Campaign Finance Board Rules:
“I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that this c ontribution is
being made from my personal funds, is not being reimbursed in any manner, and is not being made as a loan.”

Your signature required: _______________________________________________ Date Signed: ____________________




Please provide the following informat ion so we can contact you, if necessary. This information is for internal purposes only
and will not appear in required public disclosure filings:

Telephone No. (H): ____________________________ Telephone No. (W): ______________________________________

Fax number: __________________________________ E-mail address: _________________________________________

Contribution Requirements: We cannot accept: contributions from corporations, partnerships or limited liability companies (LLCs); cash
contributions that are more than $100; any contributions over $2,750. *If a contributor has business dealings with the City as defined in the
Campaign Finance Act, the contribution limit is $250. Federal law prohibits contributions from foreign nationals. We cannot a ccept
contributions from political committees, unless the committee registers with the Campaign Finance Board. If you wish to make a
contribution from an unregistered committee, call 718 -473-9828 a registration form. Contributions are not tax deductible.
State law prohibits making a contribution in someone else’s name, reimbursing someone for a contribution made in your name, being
reimbursed for a contribution made in your name, or claiming to have made a contribution when a loan is made.

CONTACT INFO Silverstein 2013: 718-473-9828                              Email Address: silverstein2013@gmail.com
Checks should be made payable to: Silverstein 2013
211-40 18th Avenue, Apt. 3K
Bayside, NY 11360

						
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