FORM C-1SUPPLEMENTAL CONTRIBUTOR INFORMATIONNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION P.O. Box 185, Trenton, NJ 08625-0185 Phone: (609) 292-8700 Website: www.elec.nj.govCONTRIBUTIONS REPORT TYPE (Select One)SECTION I. CANDIDATE, JOINT CANDIDATES, OR POLITICAL COMMITTEE INFORMATIONCandidate(s) / Committee NameStreet AddressOffice SoughtCityStateZip Code*Day Telephone*Evening TelephoneElection DateElection Type: (Select One)CountyLegal Name of Election District or MunicipalityPolitical PartySECTION II. CONTRIBUTION INFORMATIONContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountTotal This Page: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 3sForm C-1SBa Revised Aug 2024


Contributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountTotal This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 2 of 3sForm C-1SBa Revised Aug 2024




Contributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountContributor TypeLast Name / Non-Individual NameFirst Name (Leave blank if Non-Individual)Street AddressCityStateZip CodeOccupationDate ReceivedEmployer NameStreet AddressCityStateZipReceipt TypeDescription, if In-Kind ContributionAggregate AmountAmountTotal This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 3 of 3sForm C-1SBa Revised Aug 2024




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