FORM C-1
SUPPLEMENTAL CONTRIBUTOR INFORMATION
NEW 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.gov
Amendment
CONTRIBUTIONS REPORT TYPE (Select One)
Committee spending under the R-1 reporting threshold (A-1 or A-2 filers etc.) who received a contribution
in excess of $ 300 in the aggregate from one source in the election, or any currency (cash) contributions.
Committee receiving a contribution in excess of $ 1,600 in the aggregate from one source starting with the
13th day before the election up to, and including the day of the election (48-Hour Notice).
SECTION I. CANDIDATE, JOINT CANDIDATES, OR POLITICAL COMMITTEE INFORMATION
Candidate(s) Name
Committee Name
Street Address
Office Sought
GOVERNOR
SENATE
ASSEMBLY
SENATE & ASSEMBLY
COUNTY EXECUTIVE
COUNTY FREEHOLDER
CTY EXECUTIVE & FREEHOLDER
COUNTY SHERIFF
COUNTY CLERK
COUNTY REGISTRAR OF DEEDS
COUNTY SURROGATE
MAYOR
COUNCIL OR MUNICIPAL OFFICE
MAYOR & COUNCIL
FIRE COMMISSIONER
CHARTER STUDY COMMISSIONER
BALLOT QUESTION COMMITTEE
POLITICAL COMMITTEE
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Election Date
Primary
May Municipal
Fire District
Election Type:
(Select One)
General
Run-Off
Special
County
Legal Name of Election District or Municipality
Political Party
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan)
Date Received
Contributor Name
Address (Number and Street, City, State, Zip Code)
Aggregate Amount
Amount
Occupation (If Individual)
Description, if In-Kind Contribution
Check if
A
B
C
Receipt
Currency
Type:
Employer Name and Mailing Address (If Individual)
Date Received
Contributor Name
Address (Number and Street, City, State, Zip Code)
Aggregate Amount
Amount
Occupation (If Individual)
Description, if In-Kind Contribution
Check if
A
B
C
Receipt
Currency
Type:
Employer Name and Mailing Address (If Individual)
Date Received
Contributor Name
Address (Number and Street, City, State, Zip Code)
Aggregate Amount
Amount
Occupation (If Individual)
Description, if In-Kind Contribution
Check if
Receipt
A
B
C
Currency
Type:
Employer Name and Mailing Address (If Individual)
Grand Total:
Registration Number
PIN
Candidate or Treasurer
Date
*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
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sForm C-1 Revised Jan. 2019
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