FORM A-3
COMMITTEE - SWORN STATEMENT
To be used only by a continuing political committee,
political party committee, or a legislative leadership committee.
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION
P.O. Box 185, Trenton, NJ 08625-0185
Phone: (609) 292-8700
Website: www.elec.nj.gov
Calendar Year Period
Committee Type:
Jan. 1st to Dec. 31st,
Committee Name
Street Address
City
State
Zip Code
ELEC Identification Number
Committee Email
Website Committtee
(Optional)
(Optional)
Committee Chairperson and Treasurer Certification I, the undersigned, do hereby certify as follows:
The total amount to be expended by this committee shall be zero, or shall not, in the aggregate, exceed $7,200 during the calendar year
period indicated above. I have read the additional filing information on this form. I certify that my 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 Number
PIN
Registration Number
PIN
Date
Date
Chairperson
Treasurer
Address
Address
City
City
State
Zip Code
*Day Telephone
State
Zip Code
*Day Telephone
*Evening Telephone
*Evening Telephone
Additional Filing Information
In the event the total expended by this committee, in the aggregate, exceeds $7,200 at any point in the calendar year, this committee is
required to file a "Receipts and Expenditures Quarterly Report," Form R-3, on each subsequent quarterly filing date. The first of such
reports shall include all activity dating back to January 1st of the current calendar year. The filing dates are: April 15, July 15, October 15,
and January 15.
If contributions from any one source during the calendar year aggregate more than $300, or the committee receives currency (cash)
contributions in any amount, the committee is required to report the contributions to the Commission on "Supplemental Contributor
Information," Form C-3, on the next quarterly reporting date. Note that currency (cash) contributions cannot be accepted in excess of $200.
If the committee receives a contribution in excess of $1,900 in the aggregate from any one source during the period between the closing
date of the last quarterly report through the date of an election in which the committee is contributing or otherwise participating, the
committee is required to notify the Commission in writing within 48 hours of the receipt of the contribution. It is permissible for a committee
to file a cumulative report on the 11th day prior to an election of contributions in excess of $1,900 received up to the 13th day before an
election. Thereafter, each contribution in excess of $1,900 must be reported within 48 hours of receipt. Please use the "Supplemental
Contributor Information," Form C-3.
If the committee makes, incurs, or authorizes an expenditure of money or other thing of value in excess of $1,900 in the aggregate from
April 1 up to and including the day of any primary election in which the committee is participating, or from October 1 up to and including the
day of any general election in which the committee is participating, the committee is required to notify the Commission in writing within 48
hours. It is permissible for a committee to file a cumulative report on the 11th day prior to the primary or general election of expenditures
made, incurred, or authorized in excess of $1,900 up to the 13th day before the election; thereafter, each expenditure in excess of $1,900
must be reported within 48 hours. Please use the "Supplemental Expenditure Information," Form E-3.
*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.
New Jersey Election Law Enforcement Commission
Page 1 of 1
sForm A-3 Revised Jan. 2023
Required;
Continuing Political
Political Party
Legislative Leadership
Required;
Required;
Required;
Required; Format : Zipcode 12345-1234
mm/dd/yyyy
mm/dd/yyyy
Format : Zipcode 12345-1234
Format : Zipcode 12345-1234
Amendment
Check here if address is different from previously reported.
Stamp Text
Required Field
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