LEGISLATIVE LEADERSHIP COMMITTEE -
FORM D-5N
NOTICE OF MEMBERSHIP
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)
ELEC Identification Number
Chairperson Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Vice-Chairperson Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
LIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ALL OTHER MEMBERS OF THE
LEGISLATIVE LEADERSHIP COMMITTEE
Name
Mailing Address
City
State
*Day Telephone
*Evening Telephone
Zip Code
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
TREASURER CERTIFICATION: (required) I certify that the statements on this document are true and correct. I am aware that if any of the statements
are willfully false, I am subject to punishment.
Registration Number
PIN
Treasurer(req.)
Date
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 1 of 2
sForm D-5N Revised Jan. 2023
Required;
Required;
Required;
Required; Format : Zipcode 12345 or 12345-1234
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
Required;
Required;
mm/dd/yyyy
Amendment
LIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ALL OTHER MEMBERS OF THE
LEGISLATIVE LEADERSHIP COMMITTEE (continued)
Name
Mailing Address
City
State
*Day Telephone
*Evening Telephone
Zip Code
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
*Day Telephone
*Evening Telephone
Zip Code
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
Name
Mailing Address
City
State
Zip Code
*Day Telephone
*Evening Telephone
New Jersey Election Law Enforcement Commission
Page 2 of 2
sForm D-5N Revised Jan 2023
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
Format : Zipcode
Stamp Text
Required Field
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