Donations are greatly appreciated

“I certify that I am making this contribution with my own funds.  I have not been, nor will be, reimbursed by another person or entity for this contribution.  The credit card I am using is my personal card, not a corporate or business card or a card issued to another person.  I am a United States citizen or a lawfully admitted permanent resident of the United States (green card holder).  I am at least 18 years of age.  My contributions to the [name of candidate] committee will not exceed $1,000 per calendar year ($200 per calendar year for lobbyists).”