FORM C-3SUPPLEMENTAL 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)ELEC Identification NumberReport QuarterFiling YearSECTION I.Full Committee NameStreet AddressCityStateZip CodeSECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan)Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalRegistration NumberPINSignatureDateNew Jersey Election Law Enforcement CommissionPage 1 of 4sForm C-3a Revised Jun. 2021



SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan) CONTINUEDContributor Name and Address (Number, Street, City, State and Zip Code)`Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionPage 2 of 4sForm C-3a Revised Jun. 2021
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan) CONTINUEDContributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionPage 3 of 4sForm C-3a Revised Jun. 2021
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan) CONTINUEDContributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionPage 4 of 4sForm C-3a Revised Jun. 2021
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