Mail in your Contribution Please print this page , fill in ALL fields, and send along with your check to:
State Representative Eugene Miller 540 East 105,
Suite 305F Cleveland, Ohio 44108
Your Contact Information:

Name: _____________________________________________________________

Address : ___________________________________________________________

City : ____________________________________State: ________Zip: __________

Phone : _____________________________________________________________

Home Phone :_________________________Cell Phone: __________________________

Email :_____________________________________________________________

Employer :_____________________________________________________________

Occupation :_____________________________________________________________

Please sign below:
Enclosed is a check for $___________ made payable to State Representative Eugene Miller. I am making this contribution with my own personal funds and not with funds provided by any other  person.

Your Signature :_____________________________________________________________

Second Signature (for joint accounts) :_______________________________________
Date: _________________

I am humbled to serve you, and look forward to enacting legislation that will improve the lives of all Ohioans.

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