FORM DX
DESIGNATION OF DEPUTY TREASURER AND/OR
ADDITIONAL DEPOSITORY
NEW 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.state.nj.us
Amendment
Deputy Treasurer
Additional Depository
Candidate or Committee Name
Office Sought
GOVERNOR
SENATE
ASSEMBLY
SENATE & ASSEMBLY
COUNTY EXECUTIVE
COUNTY FREEHOLDER
CTY EXECUTIVE & FREEHOLDER
COUNTY SHERIFF
COUNTY CLERK
COUNTY REGISTRAR OF DEEDS
COUNTY SURROGATE
MAYOR
COUNCIL OR MUNICIPAL OFFICE
MAYOR & COUNCIL
FIRE COMMISSIONER
CHARTER STUDY COMMISSIONER
BALLOT QUESTION COMMITTEE
POLITICAL COMMITTEE
Candidate Committee Name
Street Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Election Date
Primary
May Municipal
Fire District
Election Type:
(Select One)
General
Run-Off
Special
County
Legal Name of Election District or Municipality
Political Party
DEPUTY TREASURER
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Resident Address
City
State
Zip Code
ADDITIONAL DEPOSITORY INFORMATION
1. Name of Bank or Depository
Mailing Address
City
State
Zip Code
(Area Code) Day Telephone
Account Name
Account Number
2. Name of Bank or Depository
Mailing Address
City
State
Zip Code
(Area 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.
sForm DX Revised Jul. 2013
New Jersey Election Law Enforcement Commission
Page 1 of 2
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
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
Name
Mailing Address
City
State
Zip Code
*(Area Code) Day Telephone
*(Area Code) Evening Telephone
TREASURER AND DEPUTY 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
Registration Number
PIN
Date
Deputy Treasurer
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.
Page 2 of 2
sForm DX Revised Jul. 2013
New Jersey Election Law Enforcement Commission
Processing Request...