FORM D-4
CONTINUING POLITICAL COMMITTEE -
REGISTRATION STATEMENT AND DESIGNATION OF
ORGANIZATIONAL DEPOSITORY
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION
P.O. Box 185, Trenton, NJ 08625-0185
Phone: (609) 292-8700
Website: www.elec.nj.gov
Committee Name (required)
Identifying Title or Acronym (Optional)
Street Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
ELEC Identification Number
Committee Email
Committee Website
(Optional)
(Optional)
Committee Type
County
Municipality
Political Party, if any
Type of Filing:
1. Chairperson Name (required)
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Occupation
Employer Name and Address
2. Treasurer Name (required)
Mailing Address
City
State
Zip Code
Resident Address, if different from mailing address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Occupation
Employer Name and Address
3. 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
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sForm D-4 Revised Feb. 2024
Required;
Statewide Committee
County / Local Committee
Required;
Required;
Required;
Required;
Required; Format : Zipcode 12345 or 12345-1234
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
Amendment
Initial Registration Statement
Additional Depository
Deputy Treasurer
Amendment (please specify)
Required;
Required;
DEMOCRAT
REPUBLICAN
INDEPENDENT
NONPARTISAN
3. Depository Information (continued)
Name of Bank or Depository
Mailing Address
City
State
Zip Code
Day Telephone
Account Name
Account Number
4. 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
5. General Organizational Category or Affiliation (Select One)
6. List the names/mailing addresses of the persons (other than chairperson) or entities having direct or indirect control over the
affairs of the continuing political committee. (This includes, but is not limited to persons in whose name or at whose direction or
suggestion the committee solicits funds or makes contributions.)
Name of Person or Entity
Occupation
Mailing Address
Employer Name
City
Employer Mailing Address
State, Zip Code
City, State, Zip Code
*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
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sForm D-4 Revised Feb. 2024
Required;
Business
Ideological Group
Public Question
Labor Union
Political Club
Support
Professional Association
Trade Association
Oppose
Other
Independent Expenditure Only Committee
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
6. (Continued)
Name of Person or Entity
Occupation
Mailing Address
Employer Name
City
Employer Mailing Address
State, Zip Code
City, State, Zip Code
7. List the names/mailing addresses of the persons or entities not already listed in question #6 who, directly or through an agent,
participated in the initial organization of the continuing political committee.
Name of Person or Entity
Occupation
Mailing Address
Employer Name
City
Employer Mailing Address
State, Zip Code
City, State, Zip Code
Name of Person or Entity
Occupation
Mailing Address
Employer Name
City
Employer Mailing Address
State, Zip Code
City, State, Zip Code
Name of Person or Entity
Occupation
Mailing Address
Employer Name
City
Employer Mailing Address
State, Zip Code
City, State, Zip Code
Name of Person or Entity
Occupation
Mailing Address
Employer Name
City
Employer Mailing Address
State, Zip Code
City, State, Zip Code
New Jersey Election Law Enforcement Commission
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sForm D-4 Revised Feb. 2024
8. Describe the economic, political or other particular interests and objectives to be advanced by the continuing political committee.
9. List the name and resident address of a New Jersey resident who has been designated by the continuing political committee as
the agent of the continuing political committee to accept service of legal process.
Name
Resident Address
City
State
Zip Code
10. Has any New Jersey candidate or officeholder (other than a federal candidate) established, authorized the establishment of,
maintained or participated directly or indirectly in the management or control of this continuing political committee, or will any New
Jersey candidate do so in the future?
11. What is the total amount of money this continuing political committee estimates it will raise:
(Please estimate to the best of your ability.)
This calendar year?
Next calendar year?
12. How much of the total amount of money raised is expected to be spent for New Jersey election-related activity during:
(Please estimate to the best of your ability.)
This calendar year?
Next calendar year?
13. What percentage of the total amount of money raised will be used for New Jersey election-related activity during:
(Please estimate to the best of your ability.)
This calendar year?
%
Next calendar year?
%
14. Is making contributions to New Jersey candidates or committees, or otherwise engaging in New Jersy election-related activity
expected to be a major purpose of this continuing political committee?
New Jersey Election Law Enforcement Commission
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sForm D-4 Revised Feb. 2024
Required;
YES
NO
Required;
YES
NO
Format : Zipcode
15. Besides engaging in election-related activity, what other types of expenditures will be made by this continuing political
committee?
16. Will this continuing political committee solicit any of its funds from the public for New Jersey election-related activity:
inside New Jersey
outside New Jersey
*both inside and outside New Jersey
* If "both," what percentage of the funds are expected to be raised outside New Jersey?
%
17. Will this continuing political committee solicit contributions with the stated or principal purpose of making contributions to New
Jersey candidates or committees?
18. Does this continuing political committee file with the Federal Election Commission?
19. Will this committee engage in only independent expenditure activity?
TREASURER/CHAIRPERSON CERTIFICATION
I certify that the statements on this document are true and correct. I further certify that no candidate or officeholder has established,
authorized the establishment of, maintained or participated directly or indirectly in the management or control of the Continuing Political
Committee, and no candidate or officeholder shall be permitted to do so during the existence of the Continuing Political Committee. I am
aware that if any of the statements are willfully false, I am subject to punishment.
Registration Number
PIN
Date
Treasurer (required)
Registration Number
PIN
Chairperson (required)
Date
New Jersey Election Law Enforcement Commission
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sForm D-4 Revised Feb. 2024
Required;
YES
NO
Required;
YES
NO
Required;
YES
NO
Stamp Text
Required Field
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