Committee to Elect Maggy Belizaire Lopez

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1. I am a U.S. citizen or lawfully admitted permanent resident (i.e., green card holder).
2. 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.
3. If this contribution is made with a corporate card, I certify that it is within the legal limits for corporate contributions.
4. I am at least eighteen years old.

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