I want to help Michael by (please complete this form):

Placing a sign in my yard
Placing a sign at my business
Helping with mailings to voters
Making a contribution (payable to Michael J. Dobersen for Coroner)

Amount Enclosed: $25 $50 $100 $200

Name
Address
City State Zip Code
Home Phone Business Phone
Fax Number Email

Michael can use my [our] names as a supporter:

________________________________________________

________________________________________________

Signature ________________________________________     Date ________

Then enclose your check payable to Michael J. Dobersen for Coroner and mail to:
Citizens to Elect Michael J. Dobersen
7731 South Windermere Street • Littleton, CO 80120

Thank you for your support!