JOINT CANDIDATES COMMITTEE - SWORN STATEMENTFORM A-2NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION P.O. Box 185, Trenton, NJ 08625-0185 Phone: (609) 292-8700Website: www.elec.nj.govJoint Candidates Committee NameCandidate NameCandidate NameOffice SoughtOffice SoughtCandidate NameCandidate NameOffice SoughtOffice SoughtCandidate NameCandidate NameOffice SoughtOffice SoughtStreet AddressCityStateZip Code*Day Telephone*Evening TelephoneCommittee Email (Optional)Committee Website (Optional)Election DateElection Type: (Select One)CountyLegal Name of Election District or MunicipalityPolitical PartyI, the undersigned, do hereby certify as follows:1. The total amount expended or to be expended on behalf of candidates by this committee shall be zero, or shall not, in the aggregate, exceed $11,000 for two candidates or $15,800 for three or more candidates, for this election.2. I am aware that in the event the total amount expended or to be expended on behalf of candidates by this committee, in the aggregate, exceeds $11,000 for two candidates or $15,800 for three or more candidates, I am required to file the Form R-1 (Report of Contributions and Expenditures) through ELEC eFile, on each subsequent reporting date.3. I am aware that if I receive a contribution in excess of $200 in the aggregate from one source in an election or a currency (cash) contribution in any amount, I am required to report the contribution to the Commission on Form C-1 (Supplemental Contributor Information). I am aware that I am required to identify the source and the aggregate total of the contributions therefrom, and if the contributor is an individual, his/her occupation and the name and address of his/her employer.4. I am aware that contributions received in excess of $200 in the aggregate from one source starting with the 13th day before the election, up to and including the 8th day before the election must be reported to the Commission within 72 hours of receipt, and starting with the 7th day before the election, up to and including, the day of the election, must be reported to the Commission within 24 hours of receipt. I am aware that I am required to identify the source and the aggregate total of the contributions therefrom during the period, and if the contributor is an individual, his/her occupation and the name and address of his/her employer on Form C-1 (Supplemental Contributor Information).*Leave this field blank if your telephone number is unlisted. Pursuant to N.J.S.A. 47:1A-1.1, an unlisted telephone number is not a public record and must not be provided on this form.sForm A-2 Revised Jul. 2023New Jersey Election Law Enforcement CommissionPage 1 of 2




I, the undersigned, do hereby certify as follows: (continued)5. I am aware that if I make, incur or authorize an expenditure of money or other thing of value in excess of $200 in the aggregate to support or defeat a candidate or public question, starting with the 13th day before the election, up to and including the 8th day before the election, it must be reported to the Commission within 72 hours, and starting with the 7th day before the election, up to and including, the day of the election, it must be reported to the Commission within 24 hours on Form E-1 (Supplemental Expenditure Information).6. I am aware that I am required to designate a campaign treasurer and depository by filing Form D-2 (Certificate of Organization and Designation of Campaign Treasurer and Depository) with the Commission no later than 10 days after receipt of any contribution or no later than 10 days after making any expenditure, whichever comes first.CANDIDATE CERTIFICATION: I certify that the statements on this document are true. I am aware that if any of the statements are willfully false, I may be subject to punishment.Registration NumberPINCandidateDateRegistration NumberPINCandidateDateRegistration NumberPINCandidateDateRegistration NumberPINCandidateDateRegistration NumberPINCandidateDateRegistration NumberPINCandidateDatePage 2 of 2sForm A-2 Revised Jul. 2023New Jersey Election Law Enforcement Commission
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