FORM D-1
SINGLE CANDIDATE COMMITTEE - CERTIFICATE OF
ORGANIZATION AND DESIGNATION OF CAMPAIGN
TREASURER AND DEPOSITORY
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)
Amendment
Website: www.elec.nj.gov
Candidate Name
Office Sought
GOVERNOR
SENATE
ASSEMBLY
COUNTY EXECUTIVE
COUNTY FREEHOLDER
COUNTY SHERIFF
COUNTY CLERK
COUNTY REGISTRAR OF DEEDS
COUNTY SURROGATE
MAYOR
COUNCIL OR MUNICIPAL OFFICE
FIRE COMMISSIONER
CHARTER STUDY COMMISSIONER
Candidate Committee Name
Street Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Committee Email
Committee Website
(Optional)
(Optional)
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
CHAIRPERSON
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
TREASURER
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Resident Address
City
State
Zip Code
DEPOSITORY INFORMATION
Name of Bank or Depository
Mailing Address
City
State
Zip Code
(Area Code) Day Telephone
Account Name
Account Number
*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
Page 1 of 2
sForm D-1 Revised Mar. 2018
LIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ANY PERSON(S) AUTHORIZED TO SIGN
CHECKS OR OTHERWISE MAKE TRANSACTIONS
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
CANDIDATE CERTIFICATION: I certify that the statements on this document are true. I further certify that I have not, and will not during
the existence of the candidate committee, establish, authorize the establishment of, maintain, or participate directly or indirectly in the
management or control of any political committee or continuing political committee. I am aware that if any of the statements are willfully
false, I may be subject to punishment.
Registration Number
PIN
Date
Candidate
CHAIRPERSON/TREASURER CERTIFICATION: I certify that the statements on this document are true. I am aware that if any of the
statements are willfully false, I may be subject to punishment.
Registration Number
PIN
Date
Chairperson
Registration Number
PIN
Date
Treasurer
Treasurers for Gubernatorial and Legislative candidates are required to receive training with the NJ ELEC. If you have completed the
training enter your Treasurer Training ID#
*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
Page 2 of 2
sForm D-1 Revised Mar. 2018
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