FORM C-3SUPPLEMENTAL 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)ELEC Identification NumberReport QuarterFiling YearSECTION I.Full Committee NameStreet AddressCityStateZip CodeSECTION II. CONTRIBUTION INFORMATIONContributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalRegistration NumberPINSignatureDateNew Jersey Election Law Enforcement CommissionPage 1 of 4sForm C-3a Revised May 2023Required;Committee filing "Sworn Statement," Form A-3, and receiving a contribution in excess of $300 in the aggregate from one source, or currency (cash) contributions in any amount.
Committee receiving a contribution in excess of $1,900 in the aggregate from one sourceELEC Identification Numberbetween the closing date of the last quarterly report through the date of an election in which the committee is contributing or otherwise participating (48-Hour Notice).Required;April 15
July 15
October 15
January 15Required;Required;Required;Required;Required; Format : Zipcode 12345 or 12345-1234 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyyRequired;Required; mm/dd/yyyyAmendmentCheck if address changed. Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan Check Cash Electronic In-Kind Loan SECTION II. CONTRIBUTION INFORMATION - CONTINUEDContributor Name and Address (Number, Street, City, State and Zip Code)`Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionPage 2 of 4sForm C-3a Revised May 2023 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy Format : Date mm/dd/yyyy 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 SECTION II. CONTRIBUTION INFORMATION - CONTINUEDContributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionPage 3 of 4sForm C-3a Revised May 2023 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy 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 SECTION II. CONTRIBUTION INFORMATION - CONTINUEDContributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Contributor Name and Address (Number, Street, City, State and Zip Code)Employer Name and Address (If Individual)Date ReceivedAggregate Year to DateAmountOccupation (if individual)Description, If In-Kind ContributionReceipt Type:Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionPage 4 of 4sForm C-3a Revised May 2023 mm/dd/yyyy 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