FORM C-1SUPPLEMENTAL CONTRIBUTOR INFORMATIONNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION P.O. Box 185, Trenton, NJ 08625-0185 Phone: (609) 292-8700 Website: www.elec.nj.govCONTRIBUTIONS REPORT TYPE (Select One)SECTION I. CANDIDATE, JOINT CANDIDATES, OR POLITICAL COMMITTEE INFORMATIONCandidate(s) NameCommittee NameStreet AddressOffice SoughtCityStateZip Code*Day Telephone*Evening TelephoneElection DateElection Type: (Select One)CountyLegal Name of Election District or MunicipalityPolitical PartySECTION II. CONTRIBUTION INFORMATIONDate ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Total This Page:Grand Total:Registration NumberPINCandidate or TreasurerDate*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 4sForm C-1a Revised May 2023Required;Committee spending under the R-1 reporting threshold (A-1 or A-2 filers etc.) who received a contributionin excess of $300 in the aggregate from one source in the election, or any currency (cash) contributions.
Committee receiving a contribution in excess of $1,900 in the aggregate from one source starting with the13th day before the election up to, and including the day of the election (48-Hour Notice).Required;Primary
May Municipal
Fire District
General
Run-Off
SpecialRequired;Required;Required;Required;Required; Format : Zipcode 12345 or 12345-1234 mm/dd/yyyyy Enter Contributor Name. mm/dd/yyyyy mm/dd/yyyyyRequired;Required; mm/dd/yyyyAmendmentRequired; GOVERNOR SENATE ASSEMBLY SENATE & ASSEMBLY COUNTY EXECUTIVE COUNTY COMMISSIONER CTY EXECUTIVE & COMMISSIONER COUNTY SHERIFF COUNTY CLERK COUNTY REGISTRAR OF DEEDS COUNTY SURROGATE MAYOR COUNCIL OR MUNICIPAL OFFICE MAYOR & COUNCIL FIRE COMMISSIONER CHARTER STUDY COMMISSIONER BALLOT QUESTION COMMITTEE POLITICAL COMMITTEE Required; Required; Required; Required; Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Total This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 2 of 4sForm C-1a Revised May 2023 mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Total This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 3 of 4sForm C-1a Revised May 2023 mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountDescription, if In-Kind ContributionOccupation (If Individual)Receipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionReceipt TypeEmployer Name and Mailing Address (If Individual)Total This Page:Grand Total:New Jersey Election Law Enforcement CommissionPage 4 of 4sForm C-1a Revised May 2023 mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy mm/dd/yyyyy Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Stamp TextRequired Field