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 (required)
Treasurer (required)
Address
Address
City
City
State
Zip Code
*Day Telephone
State
Zip Code
*Day Telephone
*Evening Telephone
*Evening Telephone
Additional Filing Information
1. 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.
2. If a contribution(s) are received in excess of $200 in the aggregate from one source in the calendar year, or if any currency (cash) contribution(s) are received, the committee is required to report the contribution(s) to the Commission on Form C-3 (Supplemental Contributor Information) on the next quarterly reporting date. The identify of 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 is required.
3. If contributions are received by the committee in excess of $200 from one source in the aggregate, or if any currency (cash) contributions are received, during the period between the closing date of the last quarterly report through the 13th day before the election in which the committee is participating, the committee is required to file a cumulative Form C-3 (Supplemental Contributor Information) on the 11th day before the election. Starting with the 13th day before the election, up to and including the 8th day before the election, the committee must report those contributions within 72 hours of receipt, and starting with the 7th day before the election, up to and including, the day of the election, the committee must report receipt of those contributions within 24 hours of receipt. The committee is required to identify the source and the aggregate total of the contributions therefrom during the period (13th day before to the date of the election), and if the contributor is an individual, his/her occupation and the name and address of his/her employer on Form C-3 (Supplemental Contributor Information).
4. If the committee makes, incurs or authorizes an expenditure of money or other thing of value in excess of $200 in the aggregate, during the period between the closing date of the last quarterly report through the 13th day before the election in which the committee is participating, the committee is required to file a cumulative Form E-3 (Supplemental Expenditure Information) on the 11th day before the election. Starting with the 13th day before the election, up to and including the 8th day before the election, the committee must report those expenditures within 72 hours of being made, incurred or authorized, and starting with the 7th day before the election, up to and including, the day of the election, the committee must report those expenditures within 24 hours of being made, incurred or authorized.
*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 Dec. 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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