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If donating by check or credit card, fill in appropriate blanks and mail this form to this address:
Hal Netkin for City Council 11
POB 3465
Van Nuys, CA 91407
If submitting by Fax, fax this form filled out, to 818-989-1905
If paying by check, make check payable to Hal Netkin for City Council 11
Donations are NOT tax-deductable
Federal Employer Tax Identification Number: 04-3667258
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QUESTIONS? Call 818-989-3043 or Email: NetkinCan@pacbell.net
