FORM D-3POLITICAL PARTY COMMITTEE -  DESIGNATION OF ORGANIZATIONAL
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.us
State CommitteeCounty CommitteeMunicipal CommitteeCommittee NameStreet AddressCityStateZip Code*(Area Code) Day Telephone*(Area Code) Evening TelephoneELEC Identification NumberCountyMunicipalityPolitical PartyType of Filing:Annual Designation for July 1, to June 30,Amendment (please specify)Additional DepositoryDeputy Treasurer
Chairperson NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
Treasurer NameMailing 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.Page 1 of 2sForm D-3 Revised Jul. 2013New Jersey Election Law Enforcement Commission
Depository Information (continued)Name of Bank or DepositoryMailing AddressCityStateZip Code (Area Code) Day TelephoneAccount NameAccount Number
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
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 NumberPINDateChairpersonRegistration NumberPINDateTreasurer
Treasurers for State Political Party 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.sForm D-3 Revised Jul. 2013New Jersey Election Law Enforcement CommissionPage 2 of 2
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