DESIGNATION OF DEPUTY TREASURER AND/OR FORM DXADDITIONAL 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.govCandidate or Committee NameOffice SoughtCandidate Committee NameStreet AddressCityStateZip Code*Day Telephone*Evening TelephoneElection DateElection Type: (Select One)CountyLegal Name of Election District or MunicipalityPolitical PartyDEPUTY TREASURERNameMailing AddressCityStateZip Code*Day Telephone *Evening TelephoneResident AddressCityStateZip CodeADDITIONAL DEPOSITORY INFORMATION1. Name of Bank or DepositoryMailing AddressCityStateZip CodeDay TelephoneAccount NameAccount Number2. Name 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.sForm DX Revised Jun. 2021New Jersey Election Law Enforcement CommissionPage 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 TRANSACTIONSNameMailing AddressCityStateZip Code *Day Telephone *Evening TelephoneNameMailing AddressCityStateZip Code *Day Telephone *Evening TelephoneNameMailing AddressCityStateZip Code *Day Telephone *Evening TelephoneTREASURER 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 NumberPINDateTreasurerRegistration NumberPINDateDeputy TreasurerTreasurers 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 2sForm DX Revised Jun. 2021New Jersey Election Law Enforcement Commission
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