FORM D-1G
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
Phone: (609) 292-8700
Website: www.elec.nj.gov
General Election Date
Political Party
Candidate Committee Name
Gubernatorial Candidate Name
Lieutenant Gubernatorial Candidate Name
Street Address
Street Address
City
State
Zip Code
City
State
Zip Code
*Day Telephone
*Day Telephone
*Evening Telephone
*Evening Telephone
CHAIRPERSON
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
TREASURER
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Resident Address
City
State
Zip Code
DEPOSITORY INFORMATION
Name of Bank or Depository
Mailing Address
City
State
Zip 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-1G Revised Jan. 2023
Required;
Required;
Required;
Required;
Required;
Required; Format : Zipcode 12345-1234
Format : Zipcode 12345-1234
Format : Zipcode 12345-1324
Format : Zipcode 12345-1234
Format : Zipcode 12345-1234
Format : Zipcode 12345-1234
Amendment
Required;
11/04/2025
11/02/2021
11/07/2017
11/05/2013
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
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*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 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
Gubernatorial Candidate
Registration Number
PIN
Lieutenant Gubernatorial Candidate
Date
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
Chairperson
Date
Registration Number
PIN
Treasurer
Date
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-1G Revised Jan. 2023
Format : Zipcode 12345-1234
Format : Zipcode 12345-1234
Format : Zipcode 12345-1234
Stamp Text
Required Field
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