Write In Gerrie Schipske 2018

5th District
2919 Studebaker Road
Long Beach, CA 90815
ID #Pending
Telephone: 562.201.1296 E-mail: writeingerrieschipske@gmail.com

You may use my name as a supporter:

Signature__________________________________________________________

Yes, I want to help bring Gerrie Schipske back to City Council by contributing:

______$400 ______$300 ______$200 _____$100 _______Other

Please make checks payable to:

Write in Gerrie Schipske for Council 2018

2919 Studebaker Road
Long Beach, CA 90815

Credit Card Contributions (circle one): Visa MC Amex

Personal Account or Business Account (circle one)
Name on Card: _______________________________________________________
Card Number: _____________________________Exp Date:____/_______
Security Code: (on back of card)_______________________
Signature:_____________________________________________________
(Include billing address below)

Election Law Requires the Following Information:

Name:__________________________________
Address: (no P.O. Boxes)_____________________________________________________
City/State/Zip:_____________________________________________________________
Phone:____________________________________Fax:____________________________
E-mail: (optional)___________________________________________________________
Employer:______________________________________Occupation:_________________
If self-employed, name of business:_____________________________________________
ID # if committee:_________________________________________________________

Contributions are not tax deductible as charitable contributions for income tax purposes. The
maximum contribution allowed is $400 for individuals, committees, unincorporated businesses,
corporations and unions. ID# Pending.
Paid for by Write In Gerrie Schipske for Council 2018.