Campaign Contribution Refund Claim Form

For the 2024 Election Cycle

No person may make campaign contributions to a candidate for Tallahassee City Commission or Mayor in excess of $1,000.00 per election. See s. 106.08, Florida Statutes.

Complete this form to claim a refund of contributions made between January 1, 2023, and November 5, 2024. You may file only one claim form for this election cycle. The City of Tallahassee will refund any amount up to a maximum of $25.00. The amount may include donations to one or more candidates.

Applicant Information

* First Name and Middle Initial:

* Last Name:

Best Daytime Phone Number:

* Email Address:

* Residence address (street, apartment, route):

* City:

* State:

* Zip Code:

* Date of Birth:

Voter Registration Number:

Refund Information

Enter the total amount for each donation you contributed to a candidate and the amount of your refund. Attach a receipt(s) from the candidate's campaign committee for all contributions listed.

Date	Candidate	Donation





	TOTAL CONTRIBUTION AMOUNT
	TOTAL REFUND AMOUNT (Cannot Exceed $25)

* Receipt Upload #1:

Receipt Upload #2:

Receipt Upload #3:

Receipt Upload #4:

* I certify that I have made the contribution(s) listed above, that I have not received another refund in connection with the identified contribution(s), and that I am a registered voter of the City of Tallahassee. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true.
I agree.

* Signature (click "Save Signature" when done signing)