FORM D-5NLEGISLATIVE LEADERSHIP COMMITTEE -  
NOTICE OF MEMBERSHIPNEW 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 NameELEC Identification NumberChairperson NameMailing AddressCityStateZip Code*(Area Code) Day Telephone*(Area Code) Evening Telephone
Vice-Chairperson NameMailing AddressCityStateZip Code*(Area Code) Day Telephone*(Area Code) Evening Telephone
LIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ALL OTHER MEMBERS OF THE LEGISLATIVE LEADERSHIP COMMITTEENameMailing AddressCityState *(Area Code) Day Telephone *(Area Code) Evening TelephoneZip Code
NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
TREASURER CERTIFICATION: I certify that the statements on this document are true and correct.  I am aware that if any of the statements are willfully false, I am subject to punishment.Registration NumberPINDateTreasurerTreasurers 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.sForm D-5N Revised Jul. 2013New Jersey Election Law Enforcement CommissionPage 1 of 2
LIST THE NAME(S), MAILING ADDRESS(ES) AND TELEPHONE NUMBER(S) OF ALL OTHER MEMBERS OF THE LEGISLATIVE LEADERSHIP COMMITTEE  (continued)NameMailing AddressCityState *(Area Code) Day Telephone *(Area Code) Evening TelephoneZip Code
NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening Telephone
NameMailing AddressCityState *(Area Code) Day Telephone *(Area Code) Evening TelephoneZip Code
NameMailing 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
NameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening TelephoneNew Jersey Election Law Enforcement CommissionPage 2 of 2sForm D-5N Revised Jul. 2013
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