CONTROLLER RON GALPERIN OFFICEHOLDER ACCOUNT

Contributor

First Name

Last Name

Street Address

City

State

Zip

Country

Phone

Employment

Campaign finance law requires us to obtain your occupation and employer. If you are self-employed, please list the name of the business. For occupation, please list your line of work. "Business Person" is not acceptable. Please enter the type of business instead. If you are retired, please enter "N/A" under Employee and "Retired" under Occupation; if you are a homemaker, please enter "N/A" under Employer and "Homemaker" under Occupation.

EmployerIf self-employed, enter the name of your business; if unemployed enter 'none' or 'retired'.

OccupationPlease complete even if self-employed; enter 'none' or 'retired' if unemployed.

Legal Compliance

I certify under penalty of perjury under the laws of the City of Los Angeles and the state of California that all of the following statements are true and correct.

The address provided is my residence address.
I am a United States citizen or a permanent resident alien.
This contribution is from my personal funds. This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution.
This contribution does not cause me to exceed my contribution limit of $1,500. I understand that all contributions I make to this candidate or committee must be cumulated. I understand that a contribution from another individual or entity whose contribution activity I control, such as a business that I own or control, must be aggregated with this contribution, and both contributions will be treated as a single contribution from me.
I am not a lobbyist or lobbying firm that is prohibited from contributing under Los Angeles City Charter § 470(c)(11).
I am not a bidder, sub-contractor, principal, or underwriting firm that is prohibited from contributing under Los Angeles City Charter § 470(c)(12) or 609(e).
The information provided regarding address, occupation and employer is correct.
This contribution is not being made under a false name, is not being made under another person’s name, and has not been and will not be reimbursed.
I have read and accept the Democracy Engine Terms of Service, Privacy Policy, and Refund Policy.
I am at least eighteen years old.

Additional Information

Business Name

Funds are personal funds, not business funds.

Funds are business funds, not personal funds. [Please enter business name in box above.]

Recipients & Amounts

RON GALPERIN for LOS ANGELES OFFICEHOLDER ACCOUNT (CA)
$
TOTAL
$

Payment Method

Credit CardElectronic Check

Select a payment method to continue …

Credit Card

Card Number Four_cards

Expiration Date

Security Code (CVV)

Electronic Check

Account Type

CheckingSavings

Routing (Bank) NumberOmit any dashes or spaces

Retype Routing Number

Account NumberOmit any dashes or spaces

Retype Account Number

By clicking the donate button below, I acknowledge that my payment is being made to Democracy Engine, who accepts the responsibility of distributing the funds to my designated recipient(s) in accordance with applicable campaign finance laws. My card or bank statement will show a payment to “Democracy Engine” or “DEMENG” and if there are any issues or discrepancies with the payment or I wish to revoke the payment, I can contact Democracy Engine at support@democracyengine.com. Democracy Engine will charge each recipient an applicable service fee.