LEGISLATIVE LEADERSHIP COMMITTEE -
FORM D-5
REGISTRATION STATEMENT AND DESIGNATION OF
ORGANIZATIONAL DEPOSITORY
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION
P.O. Box 185, Trenton, NJ 08625-0185
Phone: (609) 292-8700
Website: www.elec.nj.gov
Committee Name (required)
Identifying Title or Acronym (Optional)
Street Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Committee Email (Optional)
Committee Website (Optional)
Name of Legislative Leader
ELEC Identification Number
Political Party
Type of Filing:
1. TREASURER (required)
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Resident Address
City
State
Zip Code
2. DEPOSITORY INFORMATION
Name of Bank or Depository
Mailing Address
City
State
Zip Code
Day Telephone
Account Name
Account Number
*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 2
sForm D-5 Revised Jan. 2024
Required;
Senate
General Assembly
Required;
Required;
Required;
Required;
Required; Format : Zipcode 12345 or 12345-1234
Format : Zipcode
Format : Zipcode
Format : Zipcode
Amendment
Initial Registration Statement
Additional Depository
Deputy Treasurer
Amendment (please specify)
Required;
DEMOCRAT
REPUBLICAN
INDEPENDANT
NONPARTISAN
2. Depository Information (continued)
Name of Bank or Depository
Mailing Address
City
State
Zip Code
Day Telephone
Account Name
Account Number
3. LIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ANY PERSON(S) AUTHORIZED TO SIGN
CHECKS OR OTHERWISE MAKE TRANSACTIONS
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
4. LIST THE NAME AND RESIDENT ADDRESS OF A NEW JERSEY RESIDENT WHO HAS BEEN DESIGNATED BY THE LEGISLATIVE
LEADERSHIP COMMITTEE AS THE AGENT OF THE COMMITTEE TO ACCEPT SERVICE OF LEGAL PROCESS.
Name
Resident Address
City
State
Zip Code
5. A COPY OF THE BYLAWS BY THE LEGISLATIVE LEADERSHIP COMMITTEES SHALL BE FILED WITH THE
COMMISSION. SELECT ONE:
LEGISLATIVE LEADER/TREASURER CERTIFICATION: I certify that the statements on this document are true and correct. I am aware that if
any of the statements on this document are willfully false, I may be subject to punishment.
Registration Number
PIN
Date
Legislative Leader
PIN
Registration Number
Date
Treasurer (required)
Treasurers for Legislative Leadership Committees are required to receive training with the NJ ELEC. If you have completed the training
enter your Treasurer Training ID#
*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 2 of 2
sForm D-5 Revised Jan. 2024
Required;
A COPY OF THE BYLAWS IS BEING SENT UNDER SEPERATE COVER.
NO BYLAWS HAVE BEEN ADOPTED.
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
mm/dd/yyyy
mm/dd/yyyy
Stamp Text
Required Field
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