$0 – $2,500

LaShawn Henry State Senate 30th Senate District Race Announcement

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2145 2nd Ave

2145 2nd Avenue

New York, NY 10029

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Friends of LaShawn Henry 2018

YES, I’d like to support LaShawn Henry! I have enclosed my contribution of:


___$5,400 ___$3,500 ___$1,000 ___$500 ___$250 ___$100 ___$50 Other:$____


Each contribution must be accompanied by a completed and signed contribution form.

Please make checks payable to Friends of LaShawn Henry 2018 and mail along with this form to :

2110 first avenue apt.#2104 New York. NY 10029

For compliance purposes, place complete the following (Please Print):

First Name:_______________________________ Last Name__________________________________

Address:_____________________________________________________________________________

City:______________________________ State:_____________ Zip Code:________________________

Employer’s Name:_____________________________________________________________________

Occupation:__________________________________________________________________________


Please indicate if the contribution is being made by: Check (__) Cash(__) Money Order(__) credit card (__)

Credit Card Number: _ _ _ _- _ _ _ _ - _ _ _ _ - _ _ _ _ Expiration Date: ____/_____ CCV: ________


Your Signature:___________________________________________ Date:____________________

Please provide the information below so we can contact you, if necessary. This information is for internal purposes only and will not appear in required public disclosure filings:


Telephone(Mobile): _________________________________ Work: ____________________________


Fax Number:_________________________________E-mail:___________________________________






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Date and Time

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2145 2nd Ave

2145 2nd Avenue

New York, NY 10029

View Map

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