SINGLE CANDIDATE COMMITTEE - CERTIFICATE OF
FORM D-1
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
Candidate Name (required)
Office Sought
Candidate Committee Name
Street Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Committee Email (Optional)
Committee Website (Optional)
Election Date
Election Type:
County
Legal Name of Election District or Municipality
Political Party
CHAIRPERSON
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
TREASURER (required)
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-1SB Revised Jan. 2023
Required;
School Board
Required;
Required;
Required;
Required;
Required; Format : Zipcode 12345 or 12345-1234
Format : Zipcode 12345 or 12345-1234
Format : Zipcode
Format : Zipcode
Format : Zipcode
Amendment
Required;
SCHOOL BOARD
Required;
04/16/2024
11/05/2024
04/25/2023
09/26/2023
11/07/2023
03/08/2022
04/19/2022
11/08/2022
04/20/2021
11/02/2021
04/17/2029
11/06/2029
04/18/2028
11/07/2028
04/20/2027
11/02/2027
04/21/2026
11/03/2026
04/15/2025
11/04/2025
Required;
ATLANTIC COUNTY
BERGEN COUNTY
BURLINGTON COUNTY
CAMDEN COUNTY
CAPE MAY COUNTY
CUMBERLAND COUNTY
ESSEX COUNTY
GLOUCESTER COUNTY
HUDSON COUNTY
HUNTERDON COUNTY
MERCER COUNTY
MIDDLESEX COUNTY
MONMOUTH COUNTY
MORRIS COUNTY
OCEAN COUNTY
PASSAIC COUNTY
SALEM COUNTY
SOMERSET COUNTY
SUSSEX COUNTY
UNION COUNTY
WARREN COUNTY
Required;
Required;
NONPARTISAN
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 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 (required)
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
Treasurer (required)
Registration Number
PIN
Date
Chairperson
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-1SB Revised Jan. 2023
Format : Zipcode
Format : Zipcode
Format : Zipcode
Stamp Text
Required Field
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