FORM D-3POLITICAL PARTY COMMITTEE - DESIGNATION OF ORGANIZATIONAL TREASURER AND DEPOSITORYNEW 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.govCommittee NameStreet AddressCityStateZip Code*Day Telephone*Evening TelephoneELEC Identification NumberCommittee Email (Optional)Committee Website (Optional)CountyMunicipalityPolitical PartyType of Filing:to June 30,Chairperson NameMailing AddressCityStateZip Code*Day Telephone*Evening TelephoneTreasurer NameMailing AddressCityStateZip Code*Day Telephone*Evening TelephoneResident AddressCityStateZip CodeDepository InformationName of Bank or DepositoryMailing AddressCityStateZip CodeDay TelephoneAccount NameAccount 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 CommissionPage 1 of 2sForm D-3 Revised Jun. 2021
Depository Information (continued)Name of Bank or DepositoryMailing AddressCityStateZip CodeDay TelephoneAccount NameAccount NumberLIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ANY PERSON(S) AUTHORIZED TO SIGN CHECKS OR OTHERWISE MAKE TRANSACTIONSNameMailing AddressCityStateZip Code*Day Telephone*Evening TelephoneNameMailing AddressCityStateZip Code*Day Telephone*Evening TelephoneNameMailing AddressCityStateZip Code*Day Telephone*Evening TelephoneCHAIRPERSON/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 NumberPINDateChairpersonRegistration NumberPINTreasurerDateTreasurers for State Political Party Committees 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 CommissionPage 2 of 2sForm D-3 Revised Jun. 2021
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