Please join us for

a cocktail reception
and 50th birthday part
party
in support of
New York City Public Advocate
Bill de Blasio
Co-
Co-Chairs
Paul Adler • Gina Argento & John Ciafone • Tony Argento
Jordan Barowitz • Barry Berke • Sean Coffey • Sid Davidoff
Jon del Giorno • Vivian & Joseph Douek • Janice Enright • Sharon Emek
Gabrielle Fialkoff • Fred Heller • Harold Ickes • Reuvan Kaufman
Allison Lee • Tondra & Jeffrey Lynford • Joan & Mark Peters
Vincent Pitta • Pat Purcell • Bruce Ratner • Bill Samuels
Audrey Strauss • John Wilhelm
Vice-
Vice-Chairs
Sean Andrews • Aileen Doherty • Lucas Ferrara
Gianluca Galletto • Jeff Hand • Mike McGuire
Host Committee
Neil Abramson • Matty Aracich • Greg Atkins • Richard Bashner
Ranju & Ravi Batra • Leslie & Alan Beller • Herbert Block • Steve Cassidy
Arthur Cheliotes • Denise Cohen & Adam Lipson • Michael Collins
Gil Cygler • John Durso • Bunny Ellerin & Geoffrey Vincent
Marcia Ely & Andy McKey • Carmen Farina • Mike Fishman • Greg Floyd
Marian Fontana • Tom Garry • Frank Gooden • George Gresham • Al Hagan
Larry Hanley • Nancy Hollander & Ken Sunshine • Matthew Hiltzik
Denis Hughes • Craig Kaplan • Nur Khan • Ernest Logan • Steve McInnis
John Mollenkopf • Richard Moylan • Michael Mulgrew • Aaron Naparstek
Harry Nespoli • Ari Noe • Susan & Bill Rifkin • Charles Roos
Norman Seabrook • Arnie Segarra • Vinnie Serapiglia • Harendra Singh
Jim Walden • Peter Ward
—Event Committee in Formation—

Thursday, June 23, 2011

6:00 P.M. – 8:00 P.M.
Waldorf Astoria Hotel
The Empire Room
301 Park Avenue
New York, NY
To join the Host Committee or to RSVP, please contact Rafi Jafri at
(917) 975-8565 or rafijafri@gmail.com, OR Click Here
PAID FOR BY NEW YORKERS FOR DE BLASIO
 New Yorkers for de Blasio • June 23rd • Waldorf Astoria, Empire Room, 301 Park Avenue, New York, NY
rd
___ Yes, I will attend the event on June 23
Chair: $10,000 (raise)
Vice Chair: $4,950 (write or raise)
Sponsor: $2,500 (write or raise)
Host Committee: $1,000 (write or raise)
Individual: $500
(The maximum contribution for an individual to the campaign is $4,950)

$_____________ to New Yorkers for De Blasio

(Chairs, Vice Chairs, Sponsors, and Host Committee Members will be listed on the invitation)

___ Sorry, I cannot attend but would like to support the event with a contribution of:
$______________ to New Yorkers for De Blasio

Your Name: __________________________________ Your Home Address: ____________________________________

City: _______________________ State: ______________ Zip Code: __________
Your Employer’s Name: ____________________________ Your Occupation: _____________________________________
Your Work Address: _________________________________City: _______________ State: _______ Zip Code: _________
Home Phone: ____________________ Work Phone: ______________________ Cell Phone: _______________________
Fax: _______________________ E-mail address: _____________________________________________

Please indicate if contribution is being made by: Cash_______ Money Order________ Credit Card______ Check______
Contribution Amount:
____ $500 ____$1,000 ____$2,500 ____$4,950

Please charge my: ___Visa ___MasterCard ___AMEX

Credit Card No: _________________________________________ Exp. Date: _______

To make a contribution online, Click Here
Please make checks payable to: New Yorkers for De Blasio and mail to
New Yorkers for De Blasio
65 Broadway, Suite 803
New York, NY 10006

**Contributions from NYC residents up to $175 will be matched 6 to 1 by the NYC Campaign Finance Board**
The maximum contribution for an individual to the campaign is $4,950.
*For contributions of more than $400 only: Please complete “Doing Business” questionnaire.
The following statement is required by NYC Campaign Finance Board Rules:
I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that this contribution is being made from my
personal funds, is not being reimbursed in any manner, and is not being made as a loan.
Credit Card Contributors: I affirm that this contribution is being made from my personal credit card account, billed to and paid by me for my personal use and
having no corporate and business affiliation, and is not being made as a loan.

Your signature required: _________________________________________ Date signed: ________________________

Contribution Requirements:
• We cannot accept: contributions from corporations, partnerships or limited liability companies (LLCs); cash contributions that are more than $100; any
contributions over $4,950. *If a contributor has business dealings with the City as defined in the Campaign Finance Act, the contribution limit is $400.
Federal law prohibits contributions from foreign nationals. We cannot accept contributions from political committees, unless the committee registers with the
Campaign Finance Board. If you wish to make a contribution from an unregistered committee, call Ellyn Canfield at (541) 760-2637 for a registration form.
Contributions are not tax deductible.

State law prohibits making a contribution in someone else’s name, reimbursing someone for a contribution made in your name, being reimbursed for a
contribution made in your name, or claiming to have made a contribution when a loan is made.
PAID FOR BY NEW YORKERS FOR DE BLASIO
 Doing Business Questionnaire
(Required for contributions in excess of $400)

INSTRUCTIONS: There are now “doing business” contribution restrictions that cover persons who have had specific types of
business dealings with the City of New York within the past 12 months. The law applies if you are doing the business yourself, or
if you are a principal officer, principal owner, or senior manager of an entity or firm that does the business. The law may also
apply to you even if you are just bidding or applying for business. The doing business contribution restrictions only apply to
contributors listed in the City’s doing business database. If you would like more information, or to check if you are in the doing
business database, please go to the Campaign Finance Board’s website, www.nyccfb.info/candidates/candidates/doing_biz.htm.
The following categories of business are covered*:
• Lobbying: Are a registered NYC lobbyist.
• Contracts, Concessions & Franchises, and Grants: Hold these totaling over $100,000 (construction contracts over
$500,000), excluding emergency contracts and contracts awarded by competitive sealed bidding.
• Bidders and Proposers: Answer a bid or proposal request for any contract, concession, or franchise covered above.
• Economic Development Agreements: Receive a contract or agreement, including payments in lieu of taxes, City tax
incentives, and City financing.
• Pension Fund Investments: Hold contracts or proposals for investment of pension funds or related services.
• Real Property: Are a party to sales, purchases, or leases of real property with or by the City, except public auction.
• Land Use: Make any application subject to Uniform Land Use Review Procedure (“ULURP”) or application for zoning
change or special permit.

* The doing business contribution restrictions take effect in three phases: (1) contracts, concessions, franchises, and lobbyists—effective date
February 2, 2008; (2) grants, economic development agreements, pension fund agreements, bidders and proposers, and senior managers
associated with the entities covered in Phases 1 and 2—effective date July 31, 2008; (3) real property and land use—effective date December
3, 2008.

You will NOT be considered to have business dealings with the City merely because you pay real estate, income, or business
taxes or receive a refund or rebate; work for the City; pay into or receive a City pension; drive a City taxi; hire a lobbyist; seek
permits for your 1, 2, or 3 family home; apply for street activity permits including parades, processionals, or street fairs; and
other kinds of similar individual activities with the City.
……………………………………………………………………………………………………

Doing Business Contributor Form

New Yorkers for De Blasio

For contributors exceeding $400, please complete the following:

Contributor’s Name ______________________________________________________________________________________

Address ______________________________________________________________________________________________

City/State/Zip____________________________________________________________________________________________

Please indicate whether you have business dealings with the City:

YES ______ NO_______ NOT SURE______ (If yes, please complete section below):

City Agency/Agencies Name and Address of Business Category Relationships

Doing Business Entity (for example, Contracts) (for example, CEO)

PAID FOR BY NEW YORKERS FOR DE BLASIO