FORM DXDESIGNATION OF DEPUTY TREASURER AND/OR
ADDITIONAL 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
Amendment
Deputy TreasurerAdditional Depository
Candidate or Committee NameOffice SoughtCandidate Committee NameStreet AddressCityStateZip Code*(Area Code) Day Telephone*(Area Code) Evening TelephoneElection DatePrimaryMay MunicipalFire DistrictElection Type: (Select One)GeneralRun-OffSpecialCountyLegal Name of Election District or MunicipalityPolitical Party
DEPUTY TREASURERNameMailing AddressCityStateZip Code *(Area Code) Day Telephone *(Area Code) Evening TelephoneResident AddressCityStateZip Code
ADDITIONAL DEPOSITORY INFORMATION1. Name of Bank or DepositoryMailing AddressCityStateZip Code (Area Code) Day TelephoneAccount NameAccount Number
2. Name 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.sForm DX Revised Jul. 2013New Jersey Election Law Enforcement CommissionPage 1 of 2
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
TREASURER AND DEPUTY 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 NumberPINDateTreasurer
Registration NumberPINDateDeputy Treasurer
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.Page 2 of 2sForm DX Revised Jul. 2013New Jersey Election Law Enforcement Commission
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