Name:  ___________________________________

                                       (Required per election law)

Address:  _________________________________

               (Required) (P.O Boxes are not permitted per election law)

Occupation:  ______________________________

                                       (Required per election law)

Mail to:  MacKinnon for Judge 2152 South College, Ste 101, Santa Maria, CA 93454

Make checks payable to "MacKinnon for Judge"