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CONTRIBUTE BY CHECK VIA U.S. MAIL

 To contribute by check, please print/copy this page and send the requested information with a check via US mail to:

Kimon Kotos for Congress
3767 Scenic Drive
North Muskegon, MI 49445

Please make checks payable to:   Kotos for Congress

**NAME ______________________________________

**ADDRESS: __________________________________

CITY______________________STATE____ZIP_______

**EMPLOYER __________________________________
 If appropriate enter retired/self-employed/homemaker/none (unemployed).

**OCCUPATION ________________________________
 If appropriate enter retired/self-employed/homemaker/none (unemployed)

PHONE ____________________________

OFFICE PHONE _____________________

FAX ______________________________

EMAIL ____________________________

Enclosed is my check in the amount of $________

Contribution Code: __________

** Required information.  Federal Election law requires us to collect and report the name, mailing address, occupation, and name of employer of individuals whose donations exceed a total of $200 in a calendar year. You may donate up to $2,000 per primary and $2,000 per general election from your own personal funds.  Your contribution will be used in connection with Federal elections and is subject to the limits and prohibitions of the Federal Election Campaign Act.