FORM A-4
RECALL COMMITTEE - SWORN STATEMENT
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION
P.O. Box 185, Trenton, NJ 08625-0185
Phone: (609) 292-8700
Website: www.elec.nj.gov
Recall Committee Name
Recall Committee Address
Treasurer Name
Treasurer Address
Election Date
Name of Officeholder Sought to be Recalled
*Day Telephone
*Evening Telephone
Committee Email (Optional)
Committee Website (Optional)
Election Type (select one)
County
Legal Name of Election District or Municipality
Political Party, if any
I, the undersigned, do hereby certify as follows:
1. The total amount expended or to be expended on behalf of this committee shall be zero, or shall not, in the aggregate, exceed $5,800 for this election.
2. I am aware that in the event the total amount expended or to be expended on behalf of this committee shall, in the aggregate, exceed $5,800, I am required to file a ''Report of Contributions and Expenditures,'' Form R-1, on each subsequent reporting date.
3. I am aware that if this committee receives a contribution in excess of $200 in the aggregate from one source in the election or a currency (cash) contribution in any amount, I am required to report the contribution to the Commission on "Supplemental Contributor Information," Form C-1, including the identity of the source and the aggregate total of contributions therefrom, and, if the contributor is an individual, his/her occupation and the name and address of his/her employer.
4. I am aware that contributions received in excess of $200 in the aggregate from one source starting with the 13th day before the election, up to and including the 8th day before the election must be reported to the Commission within 72 hours of receipt, and starting with the 7th day before the election, up to and including, the day of the election, must be reported to the Commission within 24 hours of receipt. I am aware that I am required to identify the source and the aggregate total of the contributions therefrom during the period, and if the contributor is an individual, his/her occupation and the name and address of his/her employer on Form C-1 (Supplemental Contributor Information).
5. I am aware that if I make, incur or authorize an expenditure of money or other thing of value in excess of $200 in the aggregate to support or defeat a candidate or public question, starting with the 13th day before the election, up to and including the 8th day before the election, it must be reported to the Commission within 72 hours, and starting with the 7th day before the election, up to and including, the day of the election, it must be reported to the Commission within 24 hours on Form E-1 (Supplemental Expenditure Information).
6. I am aware that a recall committee is required to designate a campaign treasurer and a campaign depository and that I am required to file with the Commission a “Recall or Recall Defense Committee Certificate of Organization and Designation of Campaign Treasurer and Depository,” (Form RC-1), and the “Recall Committee Registration Statement ”(Form RC-2), no later than 10 days after a recall committee is established.
TREASURER CERTIFICATION :
I certify that the statements on this document are true. I am aware that if any of the
statements are willfully false, I may be subject to punishment.
Registration Number
PIN
Treasurer
Date
*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
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sForm A-4 Revised Dec. 2023
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