West Hartford Taxpayers Association, PAC

Enclosed is __________  donation.  Please make checks payable to W.H.T.A. PAC

No receipt is sent.  Please accept our thanks in advance.

Name  ________________________________________ (please print clearly)

Address  _______________________________________

Town _________________________________ State  ________  Zip Code  _______________

Phone: _________________________________

E-Mail Address  ________________________________________________________________

Employer and Occupation _____________________________________________________________

Suggested Donation: $10.00 or more.

Make Checks Payable to: W.H.T.A. PAC

Contributions to WHTA PAC are not deductible as a charitable contribution on Federal Income Tax returns. You must be at least 18 years of age and a US citizen or foreign national with a permanent US address. The amount of your donation is limited to $750 per person per calendar year, and amounts of $100 or less may be paid in cash.

 Please mail/return this form to:

West Hartford Taxpayers Association, PAC

P. O. Box 270201

West Hartford, CT 06127 – 0201

For More Information about the West Hartford Taxpayers Association visit:

www.WHTA.org

or contact:

President@WHTA.org Chris Torino (860) 586-8210

VPresident@WHTA.org Judy Aron (860) 523-7257

Paid for by WHTA PAC. George Kennedy, Treasurer. Approved by WHTA PAC