FORM C-1SUPPLEMENTAL CONTRIBUTOR INFORMATIONNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION P.O. Box 185, Trenton, NJ 08625-0185 (609) 292-8700 or Toll Free Within NJ 1-888-313-ELEC (3532) Website: www.elec.nj.govCONTRIBUTIONS REPORT TYPE (Select One)SECTION I. CANDIDATE, JOINT CANDIDATES, OR POLITICAL COMMITTEE INFORMATIONCandidate(s) NameCommittee NameStreet AddressOffice SoughtCityStateZip Code*Day Telephone*Evening TelephoneElection Type: Election Date(Select One)CountyLegal Name of Election District or MunicipalityPolitical PartySECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Grand Total:Registration NumberPINCandidate or TreasurerDate*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 CommissionPage 1 of 1sForm C-1 Revised Jun. 2021





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