SINGLE CANDIDATE COMMITTEE - CERTIFICATE OF FORM D-1G ORGANIZATION AND DESIGNATION OF CAMPAIGN
TREASURER AND DEPOSITORYNEW 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.usAmendment
General Election DatePolitical PartyCandidate Committee NameGubernatorial Candidate NameLieutenant Gubernatorial Candidate Name
Street AddressStreet AddressCityStateZip CodeCityStateZip Code*(Area Code) Day Telephone*(Area Code) Day Telephone*(Area Code) Evening Telephone*(Area Code) Evening Telephone
CHAIRPERSONNameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
TREASURERNameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening TelephoneResident AddressCityStateZip Code
DEPOSITORY INFORMATIONName of Bank or DepositoryMailing AddressCityStateZip Code (Area Code) Day TelephoneAccount NameAccount 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 CommissionPage 1 of 2sForm D-1G Revised Mar. 2013
LIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ANY PERSON(S) AUTHORIZED TO SIGN CHECKS OR OTHERWISE MAKE TRANSACTIONSNameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
CANDIDATE CERTIFICATION: I certify that the statements on this document are true. I further certify that I have not, and will not during the existence of the candidate committee, establish, authorize the establishment of, maintain, or participate directly or indirectly the management or control of any political committee or continuing political committee. I am aware that if any of the statements are willfully false, I may be subject to punishment.Registration NumberPINDateGubernatorial Candidate
Registration NumberPINDateLieutenant Gubernatorial Candidate
CHAIRPERSON/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 NumberPINDateChairperson
Registration NumberPINDateTreasurer
Treasurers for Gubernatorial and Legislative candidates 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 CommissionPage 2 of 2sForm D-1G Revised Mar. 2013
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