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Please donate locally to ensure local republican candidates are elected.
SMITH COUNTY REPUBLICAN PARTY
Contribution Form
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____YES!! I am pleased to support the Smith County Republican Party by enclosing my
contribution in the amount of:
___$100
___$250
___$1000
$50 ____$25 ____ (other) $______
Make checks payable to:
SMITH COUNTY REPUBLICAN PARTY
NAME(s)_____________________________________________________
HOME ADDRESS______________________________________________
CITY____________________________ STATE_______ ZIP____________
PHONE Daytime ________________ Home ________________________
Fax________________________ E-Mail___________________________
Federal law requires political committees to report the name, mailing address, occupation, and
name of employer for each individual whose contributions aggregate in excess of $200 in
calendar year.
Your Employer: ___________________________________________________
Occupation: ______________________________________________________
This form can be printed and then filled out.
Mail completed form, along with your check, to:
Smith County Republican Party
3923 South Broadway Ave.
Tyler, TX. 75702
Donation form
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