I understand that NY 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 and/or business funds, is not being reimbursed in any manner, and is not being made as
a loan. My contribution is NOT tax deductible. NY 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.