FORM C-1SUPPLEMENTAL CONTRIBUTOR INFORMATION
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION  P.O. Box 185, Trenton, NJ 08625-0185 (609) 292-8700 or Toll Free Within NJ 1-888-313-ELEC (3532) Website: www.elec.state.nj.us
Amendment
CONTRIBUTIONS REPORT TYPE (Select One)Committee spending under the R-1 reporting threshold (A-1 or A-2 filers etc.) who received a contribution in excess of $ 300 in the aggregate from one source in the election, or any currency (cash) contributions.Committee receiving a contribution in excess of $ 1,400 in the aggregate from one source starting with the 13th day before the election up to, and including the day of the election (48-Hour Notice).
SECTION I. CANDIDATE, JOINT CANDIDATES, OR POLITICAL COMMITTEE INFORMATIONCandidate(s) NameCommittee NameStreet AddressOffice SoughtCityStateZip Code*(Area Code) Day Telephone*(Area Code) Evening TelephoneElection DatePrimaryMay MunicipalFire DistrictElection Type: (Select One)GeneralRun-OffSpecialCountyLegal Name of Election District or MunicipalityPolitical Party
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan)Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionCheck if Receipt CurrencyType:Employer Name (If Individual)Employer Mailing Address (If Individual)
Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionCheck if Receipt CurrencyType:Employer Name (If Individual)Employer Mailing Address (If Individual)
Date ReceivedContributor NameAddress (Number and Street, City, State, Zip Code)Aggregate AmountAmountOccupation (If Individual)Description, if In-Kind ContributionCheck if Receipt CurrencyType:Employer Name (If Individual)Employer Mailing Address (If Individual)
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 1sForm C-1 Revised Jul. 2013
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