FORM G-1ACandidate Certification for Public Financing andDebate ParticipationNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSIONP.O. Box 185, Trenton, NJ 08625-0185(609) 292-8700 or Toll Free Within NJ 1-888-313-ELEC (3532)www.elec.nj.govCandidate Name :Street Address :City, State, Zip :Election Date : Office Sought :Select an option below:I have raised at least $490,000, in contributions eligible for match, have spent or am committed to spend $490,000, and have1.submitted or will be submitting Form P-1, demonstrating those contributions and expenditures;I am obligated to participate in a series of interactive debates, (2 as a gubernatorial candidate, 1 as a lieutenant gubernatorial2.candidate), each of which shall be at least one hour in duration. I acknowledge the timing, contents and procedures set forthin N.J.S.A. 19:44A-46, for the prescribed debates and agree to those terms as conditions of receiving public matching funds.3.I further acknowledge that should the Commission find that I failed to participate in a required debate(s) without justification orexcuse, I am liable for the return of public funds received, consistent with N.J.S.A. 19:44A-47; and4.Simultaneously with filing Form P-1, I have filed Form P-2 or Form P-2A, for the disclosure of issue advocacy participation,and will continue to file Form P-2 with every submission and report, consistent with N.J.A.C. 19:25-16.18A andN.J.A.C. 19.25-15.17A.I have raised at least $490,000, in contributions and have spent or am committed to spend $490,000, and have submitted or1.will be submitting the required documentation demonstrating those contributions and expenditures; andI intend to participate in a series of interactive debates, (2 as a gubernatorial candidate, 1 as a lieutenant gubernatorial2.candidate), each of which shall be at least one hour in duration. I acknowledge the timing, contents and procedures set forthin N.J.S.A. 19:44A-46, for the prescribed debates and agree to those terms as conditions of participating.I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me arewillfully false, I may be subject to punishment.Registration NumberPinCandidateDateNew Jersey Election Law Enforcement CommissionPage 1 of 1Form G-1A Revised: Jun. 2021
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