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FRIENDS OF DENNY COFFMAN
77-258 Ho'oka'ana Street
Kailua Kona, HI 96740

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State law requires that all campaign contributions be accompanied by a valid mailing address. Name:   Address:   City:   State:   HI AK AL AR AZ CA CO CT DE FL GA IA ID IL IN KS KY LA MA MD MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip:   Occupation:   Employer:    By submitting this form I confirm that the following statements are true and accurate: I am not a foreign national who lacks permanent residence in the United States. This contribution is made from my own funds, and not those of another. This contribution is not made from the funds of a corporation or labor organization. This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay, and is not made either on a corporate or business entity card or on the card of another person. I am at least eighteen years old. I understand I can contribute a maximum of $2000.00 Donations are not deductible for federal income tax purposes.