FORM IND
REPORT OF INDEPENDENT EXPENDITURES
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.nj.gov
Name
Street Address
City
State
Zip Code
Day Telephone
Election Type:
Election Date
(Select One)
County
Legal Name of Election District or Municipality
Political Party
If the name entered above is an individual, please provide below the individual's occupation, and the name and address of the
individual's employer.
Occupation
Employer Name
Employer Address
EXPENDITURE INFORMATION
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Full Mailing Address
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Full Mailing Address
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Full Mailing Address
Payment Date
Check No.
Purpose
Amount Incurred/Not Paid
Amount Disbursed
Full Name of Payee
Full Mailing Address
Total for Election
Total Disbursed
Total, Incurred/Not Paid
Registration Number
PIN
Name
Date
*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
Page 1 of 1
sForm IND Revised Jun. 2021
Required;
Primary
May Municipal
Fire District
General
Run-Off
Special
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Required;
Required;
Required;
Required; Format : Zipcode 12345 or 12345-1234
mm/dd/yyyy
Required;
Required;
mm/dd/yyyy
Amendment
Required;
Required;
N/A
ATLANTIC COUNTY
BERGEN COUNTY
BURLINGTON COUNTY
CAMDEN COUNTY
CAPE MAY COUNTY
CUMBERLAND COUNTY
ESSEX COUNTY
GLOUCESTER COUNTY
HUDSON COUNTY
HUNTERDON COUNTY
MERCER COUNTY
MIDDLESEX COUNTY
MONMOUTH COUNTY
MORRIS COUNTY
OCEAN COUNTY
PASSAIC COUNTY
SALEM COUNTY
SOMERSET COUNTY
SUSSEX COUNTY
UNION COUNTY
WARREN COUNTY
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Stamp Text
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