FORM C-3SUPPLEMENTAL 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
CONTRIBUTIONS REPORT TYPE (Select One)AmendmentCommittee 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 $1,400 in the aggregate from one source ELEC 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).
Report QuarterApril 15July 15October 15January 15Filing Year
SECTION I.Check if address has changed.Full Committee NameStreet AddressCityStateZip Code
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan)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 ContributionCheck if Receipt CurrencyType:
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 ContributionCheck if Receipt CurrencyType:
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 ContributionCheck if Receipt CurrencyType:
Total This PageGrand Total
Registration NumberPINSignatureDatesForm C-3a Revised Jul. 2013New Jersey Election Law Enforcement CommissionPage 1 of 4
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan) 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 ContributionCheck if Receipt Type:Currency
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 ContributionCheck if Receipt Type:Currency
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 ContributionCheck if Receipt Type:Currency
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 ContributionCheck if Receipt CurrencyType:
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 ContributionCheck if Receipt CurrencyType:
Total This PageGrand TotalsForm C-3a Revised Jul. 2013New Jersey Election Law Enforcement CommissionPage 2 of 4
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan) 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 ContributionCheck if Receipt Type:Currency
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 ContributionCheck if Receipt CurrencyType:
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 ContributionCheck if Receipt Type:Currency
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 ContributionCheck if Receipt CurrencyType:
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 ContributionCheck if Receipt CurrencyType:
Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionPage 3 of 4sForm C-3a Revised Jul. 2013
SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan) 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 ContributionCheck if Receipt Type:Currency
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 ContributionCheck if Receipt CurrencyType:
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 ContributionCheck if Receipt Type:Currency
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 ContributionCheck if Receipt CurrencyType:
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 ContributionCheck if Receipt Type:Currency
Total This PageGrand TotalNew Jersey Election Law Enforcement CommissionsForm C-3a Revised Jul. 2013Page 4 of 4
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