LEGISLATIVE LEADERSHIP COMMITTEE - FORM D-5REGISTRATION STATEMENT AND DESIGNATION OF ORGANIZATIONAL 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 NameIdentifying Title or Acronym (Optional)Street AddressCityStateZip Code*Day Telephone*Evening TelephoneCommittee Email (Optional)Committee Website (Optional)Name of Legislative LeaderELEC Identification NumberPolitical PartyType of Filing:1. TREASURERNameMailing AddressCityStateZip Code*Day Telephone*Evening TelephoneResident AddressCityStateZip Code2. DEPOSITORY INFORMATIONName of Bank or DepositoryMailing AddressCityStateZip Code Day 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-5 Revised Jun. 2021
2. Depository Information (continued)Name of Bank or DepositoryMailing AddressCityStateZip Code Day TelephoneAccount NameAccount Number3. LIST 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 Telephone4. LIST THE NAME AND RESIDENT ADDRESS OF A NEW JERSEY RESIDENT WHO HAS BEEN DESIGNATED BY THE LEGISLATIVE LEADERSHIP COMMITTEE AS THE AGENT OF THE COMMITTEE TO ACCEPT SERVICE OF LEGAL PROCESS.NameResident AddressCityStateZip Code5. A COPY OF THE BYLAWS BY THE LEGISLATIVE LEADERSHIP COMMITTEES SHALL BE FILED WITH THE COMMISSION. SELECT ONE:LEGISLATIVE LEADER/TREASURER CERTIFICATION: I certify that the statements on this document are true and correct. I am aware that if any of the statements on this document are willfully false, I may be subject to punishment.Registration NumberPINDateLegislative LeaderPINRegistration NumberDateTreasurerTreasurers for Legislative Leadership 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-5 Revised Jun. 2021
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