FORM A-4RECALL COMMITTEE - SWORN STATEMENTNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION P.O. Box 185, Trenton, NJ 08625-0185 Phone: (609) 292-8700 Website: www.elec.nj.govRecall Committee NameRecall Committee AddressTreasurer NameTreasurer AddressElection DateName of Officeholder Sought to be Recalled*Day Telephone*Evening TelephoneCommittee Email (Optional)Committee Website (Optional)Election Type (select one)CountyLegal Name of Election District or MunicipalityPolitical Party, if anyI, the undersigned, do hereby certify as follows:1. The total amount expended or to be expended on behalf of this committee shall be zero, or shall not, in the aggregate, exceed $5,800 for this election.2. I am aware that in the event the total amount expended or to be expended on behalf of this committee shall, in the aggregate, exceed $5,800, I am required to file a ''Report of Contributions and Expenditures,'' Form R-1, on each subsequent reporting date. 3. I am aware that if this committee receives a contribution in excess of $300 in the aggregate from one source in the election or a currency (cash) contribution in any amount, I am required to report the contribution to the Commission on "Supplemental Contributor Information," Form C-1, including the identity of the source and the aggregate total of contributions therefrom, and, if the contributor is an individual, his/her occupation and the name and address of his/her employer.4. I am aware that if I receive a contribution in excess of $1,900 in the aggregate from one source starting with the 13th day before the election up to, and including, the day of the election, I am required to notify the Commission in writing on the "Supplemental Contributor Information, " Form C-1, within 48 hours of receipt of the contribution and to identify the source and the aggregate amount received therefrom during the period, and, if the contributor is an individual, his/her occupation and the name and address of his/her employer.5. I am aware that if I make, incur, or authorize an expenditure of money or other thing of value in excess of $1,900 in the aggregate to support or defeat a candidate or public question, starting with the 13th day before the election up to and including the day of the election, I am required to notify the Commission in writing within 48 hours of the expenditure on the "Supplemental Expenditure Information," Form E-1.6. I am aware that a recall committee is required to designate a campaign treasurer and a campaign depository and that I am required to file with the Commission a “Recall or Recall Defense Committee Certificate of Organization and Designation of Campaign Treasurer and Depository,” (Form RC-1), and the “Recall Committee Registration Statement ”(Form RC-2), no later than 10 days after a recall committee is established.TREASURER CERTIFICATION :I certify that the statements on this document are true. I am aware that if any of thestatements are willfully false, I may be subject to punishment.Registration NumberPINTreasurerDate*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 A-4 Revised Jan. 2023
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