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) NameCommittee NameStreet AddressOffice SoughtCityStateZip Code*Day Telephone*Evening TelephoneElection DateElection Type: (Select One)CountyLegal Name of Election District or MunicipalityPolitical PartySECTION II. CONTRIBUTION INFORMATIONDate 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)Total 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 4sForm C-1a Revised Jan. 2023





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)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)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)Total This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 2 of 4sForm C-1a Revised Jan. 2023
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)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)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)Total This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 3 of 4sForm C-1a Revised Jan. 2023
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 AmountAmountDescription, if In-Kind ContributionOccupation (If Individual)Receipt 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)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)Total This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 4 of 4sForm C-1a Revised Jan. 2023
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