FORM INDREPORT OF INDEPENDENT EXPENDITURESNEW 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.govNameStreet AddressCityStateZip CodeDay TelephoneElection Type: Election Date(Select One)CountyLegal Name of Election District or MunicipalityPolitical PartyIf the name entered above is an individual, please provide below the individual's occupation, and the name and address of the individual's employer.OccupationEmployer NameEmployer AddressEXPENDITURE INFORMATIONPayment DateCheck No.PurposeAmount Incurred/Not PaidAmount DisbursedFull Name of PayeeFull Mailing AddressPayment DateCheck No.PurposeAmount Incurred/Not PaidAmount DisbursedFull Name of PayeeFull Mailing AddressPayment DateCheck No.PurposeAmount Incurred/Not PaidAmount DisbursedFull Name of PayeeFull Mailing AddressPayment DateCheck No.PurposeAmount Incurred/Not PaidAmount DisbursedFull Name of PayeeFull Mailing AddressTotal for ElectionTotal DisbursedTotal, Incurred/Not PaidRegistration NumberPINNameDate*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 1sForm IND Revised Jun. 2021




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