SUPPLEMENTAL EXPENDITURE INFORMATION
FORM E-3
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION
P.O. Box 185, Trenton, NJ 08625-0185
Phone: (609) 292-8700
Website: www.elec.nj.gov
To be filed by a committee within 72 or 24 hours of any expenditure of money or other thing of value in excess of $200 in the aggregate
made, incurred, or authorized.
Filing Period (Select One)
Full Committee Name
Street Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
ELEC Identification Number
EXPENDITURE INFORMATION
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Total This Page
Grand Total
Registration Number
PIN
Date
Treasurer
*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
sForm E-3a Revised Dec. 2023
Page 1 of 4
Required;
From April 1st up to and including the Primary Election Date
From October 1st up to and including the General Election Date
Required;
Required;
Required;
Required;
Required; Format : Zipcode 12345 or 12345-1234
mm/dd/yyyy
Required;
Required;
mm/dd/yyyy
Amendment
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Total This Page
Grand Total
New Jersey Election Law Enforcement Commission
Page 2 of 4
sForm E-3a Revised Dec. 2023
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Total This Page
Grand Total
New Jersey Election Law Enforcement Commission
Page 3 of 4
sForm E-3a Revised Dec. 2023
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Independent Expenditure
Full Mailing Address
Expenditures on Behalf of Candidate(s)/Committee(s) (Identify Recipient)
Candidate/Committee Full Name
Election Date
Election District or Municipality
Prorated Amount
Total This Page
Grand Total
New Jersey Election Law Enforcement Commission
Page 4 of 4
sForm E-3a Revised Dec. 2023
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