FORM D-5LEGISLATIVE LEADERSHIP COMMITTEE -  REGISTRATION STATEMENT AND DESIGNATION OF
ORGANIZATIONAL 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
Committee NameIdentifying Title or Acronym (Optional)Street AddressCityStateZip Code*(Area Code) Day Telephone*(Area Code) Evening TelephoneName of Legislative LeaderSenateGeneral AssemblyELEC Identification NumberPolitical Party
Type of Filing:Initial Registration StatementAdditional DepositoryDeputy TreasurerAmendment (please specify)
1. TREASURERNameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening TelephoneResident AddressCityStateZip Code
2. 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-5 Revised Jul. 2013
2. Depository Information (continued)Name of Bank or DepositoryMailing AddressCityStateZip Code (Area Code) Day TelephoneAccount NameAccount Number
3. 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 TelephoneNameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
4.  LIST THE NAME AND RESIDENT ADDRESS OF A NEW JERSEY RESIDENT WHO HAS BEEN DESIGNATED BY THE LEGISLATIVE LEADERSHIP COMMITTEE AS THE AGENT OF THE COMMITTEE TO ACCEPT SERVICE OF LEGAL PROCESS.NameResident AddressCityStateZip Code
5. A COPY OF THE BYLAWS BY THE LEGISLATIVE LEADERSHIP COMMITTEES SHALL BE FILED WITH THE COMMISSION. SELECT ONE:A COPY OF THE BYLAWS IS BEING SENT UNDER SEPERATE COVER.NO BYLAWS HAVE BEEN ADOPTED.
LEGISLATIVE LEADER/TREASURER CERTIFICATION: I certify that the statements on this document are true and correct.  I am aware that if any of the statements on this document are willfully false, I may be subject to punishment.Registration NumberPINDateLegislative LeaderRegistration NumberPINDateTreasurer
Treasurers for Legislative Leadership 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.New Jersey Election Law Enforcement CommissionPage 2 of 2sForm D-5 Revised Jul. 2013
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