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RECEIPTS AND EXPENDITURES QUARTERLY REPORT

NEW 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) www.elec.nj.gov

PLEASE TYPE OR PRINT

FORM R-3

FOR STATE USE ONLY

Committee Name or Approved Acronym

Address (Number and Street) Check if different than previously reported

City, State, Zip Code			ELEC Identification Number

Committee Type	Check if:		Report Quarter
 CPC  PPC  LLC	 Amendment	 First Report Filed	 Apr 15  Jul 15  Oct 15  Jan 15 Year_________

Do not attempt to complete the “Depository Information” or the “Net Financial Summary” until the appropriate schedules have been completed.

DEPOSITORY INFORMATION				Column A	Column B

		From	Through		Calendar
Period Covered				This Report	Year-to-Date

1.	Cash on Hand, January 1, _______________

2.	Cash on Hand, Beginning of Reporting Period

3.	Monetary Receipts		(+)

4.	Subtotal

5.	Monetary Expenditures		(–)

6.	Cash on Hand, Close of Reporting Period

NET FINANCIAL SUMMARY

7.	Cash on Hand, Close of Reporting Period

8.	Debt owed to Committee	(+)

9.	Subtotal

10.	Debt Owed by Committee	(–)

11.	Total (Net Worth)

TREASURER CERTIFICATION

I certify that the statements on this document are true, and that the contribution amounts received conform with the limitations designated by law. I am aware that if any of the statements are willfully false, I may be subject to punishment.

_______________________	______________________________________	_____________________________________
DATE	PRINT NAME	SIGNATURE
	______________________________________	_____________________________________
	ADDRESS	*(AREA CODE) DAY TELEPHONE NUMBER
	______________________________________	_____________________________________
		*(AREA CODE) EVENING TELEPHONE NUMBER

New Jersey Election Law Enforcement Commission		Form R-3 Page 1 of 11 Revised: 02.28.2018

*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.

Do not attempt to complete Tables I and II until the appropriate schedules have been completed.

TABLE I RECEIPTS			Column A	Column B

				Calendar
Monetary Receipts			This Report	Year-to-Date

1.	Contributions, $300 or less

2.	Contributions, more than $300 (Schedule A)

2a.	Currency Contributions (Schedule A)

3.	Total (Add lines 1, 2 and 2a)

4.	Refund of Contributions (Adjustment Schedule)	(–)

5.	Subtotal (Subtract line 4 from line 3)

	Other Receipts

6.	Reimbursements/Refunds (Schedule A)

7.	Dividends/Interest (Schedule A)

8.	Loans Received by Committee, $300 or Less

9.	Loans Received by Committee more than $300 and all
	Currency Loans (Schedule B)

10.	Total Monetary Receipts (Add lines 5 through 9)

11.	In-kind Contributions, $300 or less

12.	In-kind Contributions, more than $300 (Schedule A)

13.	Gross Receipts (Add lines 10, 11 and 12)

TABLE II EXPENDITURES

14.	Operating Disbursement (Schedule C)

	Contributions (from the Committee) to:

15a.	NJ Gubernatorial Candidates/Committees (Schedule D)

15b.	NJ Legislative Candidates/Committees (Schedule D)

15c.	All other Candidates/Committees (Schedule D)

	Expenditures Made on Behalf of:

16a.	NJ Gubernatorial Candidates/Committees (Schedule E)

16b.	NJ Legislative Candidates/Committees (Schedule E)

16c.	All other Candidates/Committees (Schedule E)

16d. Independent Expenditures (Schedule E)

17.	Loan Payments (Schedule B)

18.	Total Monetary Expenditures (Add lines 14 through 17)

19.	In-kind contributions, $300 or Less (Table I, Line 11)

20.	In-kind contributions, more than $300 (Table I, Line 12)

21.	Gross Expenditures (Add lines 18 through 20)

New Jersey Election Law Enforcement Commission

Form R-3 Page 2 of 11 Revised: 02.28.2018

DEPOSITORY SUMMARY - PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.

Committee Name:

BANK ACCOUNT INFORMATION

1. Name of Bank

(Area Code) Telephone Number

Mailing Address

City, State, Zip Code

Account Name

Opening Balance this Period

Deposits this Period

Disbursements this Period

Closing Balance this Period

If the committee has more than one bank account within the same bank, the name(s) of the additional account(s) must be provided.

Account Name

Opening Balance this Period	Deposits this Period	Disbursements this Period		Closing Balance this Period

2. Name of Bank			(Area Code) Telephone Number

Mailing Address

City, State, Zip Code

Account Name

Opening Balance this Period	Deposits this Period	Disbursements this Period		Closing Balance this Period

If the committee has more than one bank account within the same bank, the name(s) of the additional account(s) must be provided.

Account Name

Opening Balance this Period

Deposits this Period

Disbursements this Period

Closing Balance this Period

OTHER ASSETS

Other than the bank account(s) listed above, does this committee hold any of the following (please X):

 Investment Institution Money Market Account	 Bonds
 Certificate of Deposit (C.D.)	 Stocks
 Mutual Fund Account	 Real Property

Other (please specify) _______________________________________________________________________________

For each item checked (“X”) above (other than real property), please complete the following information. If real property is held, a Real Property Schedule must be filed as part of the Form R-3. Contact the Commission for a Real Property Schedule and instructions.

1. Name of Depository or Issuer	(Area Code) Telephone Number

Mailing Address

City, State, Zip Code

Account Name

Type of Asset
 Money Market	 C.D.	 Mutual Fund	 Bonds	 Stocks	 Other (specify) ____________________

Value of Asset at Purchase if Applicable				Date of Maturity, if Applicable

Opening Balance this Period

Deposits this Period

Disbursements this Period

Closing Balance this Period

New Jersey Election Law Enforcement Commission

Form R-3 Page 3 of 11 Revised: 02.28.2018

ITEMIZED RECEIPTS (Other than Loans)

SCHEDULE A

Page No.

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.

Receipt Type (Use a separate “Schedule A” for each type and for each separate account.)

 Currency	 All other Monetary Contributions	 In-Kind Contributions-Expenditures Made by Others
 Reimbursements/Refunds of Disbursements		 Dividends/Interest

Committee Name

Account Name

Contributor Name

Contributor Address (Number and Street)

Occupation

City, State, Zip Code

Employer Name

Employer Address

Date(s) Received this Period

Amount(s) Received this Period

City, State, Zip Code

Receipt Description (If In-Kind)

Aggregate Year-to-Date

Contributor Name

Contributor Address (Number and Street)

Occupation

City, State, Zip Code

Employer Name

Date(s) Received

Amount(s) Received

Employer Address

City, State, Zip Code

Receipt Description (If In-Kind)

Aggregate Year-to-Date

Contributor Name

Contributor Address (Number and Street)

Occupation

City, State, Zip Code

Employer Name

Date(s) Received

Amount(s) Received

Employer Address

City, State, Zip Code

Receipt Description (If In-Kind)

Aggregate Year-to-Date

Contributor Name

Contributor Address (Number and Street)

Occupation

City, State, Zip Code

Employer Name

Date(s) Received

Amount(s) Received

Employer Address

City, State, Zip Code

Receipt Description (If In-Kind)

Aggregate Year-to-Date

1.SUBTOTAL (Add all receipts listed on this page.)

2.TOTAL RECEIPTS, THIS PERIOD (Complete this line on the last page used for each receipt type. Carry forward to applicable line on Page 2, Column A.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 4 of 11 Revised: 02.28.2018

LOANS RECEIVED				SCHEDULE B	Page No.		of

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.
Use a separate “SCHEDULE B” for each separate account.

Committee Name

Account Name

Name and Address of Lender		Original Loan	New Loan		Total Amount of		Outstanding Balance
		Amount	this Period		Loan Plus Interest		this Period

		Payments this Period	Amount		Check No(s)		Date(s)

Occupation		Terms:	Date Incurred		Date Due		Annual Interest Rate
		Terms:

Employer Name and Address (Number, Street, City, State and Zip Code)						Aggregate Year-to-Date

1. Name and Address of Guarantor						Amount Outstanding

Occupation	Employer Name and Address (Number, Street, City, State and Zip Code)					Aggregate Year-to-Date

2. Name and Address of Guarantor						Amount Outstanding

Occupation	Employer Name and Address (Number, Street, City, State and Zip Code)					Aggregate Year-to-Date


Name and Address of Lender		Original Loan	New Loan		Total Amount of		Outstanding Balance
		Amount	this Period		Loan Plus Interest		this Period

		Payments this Period	Amount		Check No(s)		Date(s)

Occupation		Terms	Date Incurred		Date Due		Annual Interest Rate

Employer Name and Address (Number, Street, City, State and Zip Code)						Aggregate Year-to-Date

1. Name and Address of Guarantor						Amount Outstanding

Occupation	Employer Name and Address (Number, Street, City, State and Zip Code)					Aggregate Year-to-Date

2. Name and Address of Guarantor						Amount Outstanding

Occupation	Employer Name and Address (Number, Street, City, State and Zip Code)					Aggregate Year-to-Date


1. TOTAL NEW LOANS, THIS PERIOD (Complete this line on the last page used.
Carry forward to Page 2, Line 9, Column A.)

2. TOTAL AMOUNT OF LOANS PLUS INTEREST, THIS PERIOD

3. TOTAL LOAN PAYMENTS, THIS PERIOD (Complete this line on the last page used.
Carry forward to Page 2, Line 17, Column A.)

4. TOTAL OF ALL OUTSTANDING LOANS PLUS INTEREST (Complete this line on the
last page used. Carry back to Page 10, “Schedule F”, Line 1.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 5 of 11 Revised: 02.28.2018

ADJUSTMENT SCHEDULE - REFUND OF CONTRIBUTIONS			Page No.	of

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.
Use a separate “ADJUSTMENT SCHEDULE” for each separate account.

Committee Name

Account Name

IF A MONETARY CONTRIBUTION IN EXCESS OF THE CONTRIBUTION LIMIT IS DEPOSITED, PLEASE REPORT
THE REFUND OF THE EXCESS AMOUNT ON THIS ADJUSTMENT SCHEDULE.

Payment Date	Check No.	Payee Name and Address		Refunded Amount













1. TOTAL REFUND OF CONTRIBUTIONS, THIS PERIOD (Complete this line on the last page
used. Carry forward to Page 2, Line 4, Column A.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 6 of 11 Revised: 02.28.2018

ITEMIZED OPERATING DISBURSEMENTS

SCHEDULE C

Page No.

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED. Use a separate “SCHEDULE C” for each separate account.

Committee Name

Account Name

Payee or Creditor Name, Address (Number, Street, State, City, State and Zip Code)

Purpose*

Amount(s)

Disbursed this

Period

Transaction Dates

Check No(s)

*Legislative Leadership Committees - See instructions concerning permissible uses of funds.

1.SUBTOTAL (Add all disbursements listed on this page.)

2.TOTAL DISBURSEMENTS, THIS PERIOD (Complete this line on the last page used. Carry forward to Page 2, Line 14, Column A.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 7 of 11 Revised: 02.28.2018

ITEMIZED MONETARY CONTRIBUTIONS MADE TO CANDIDATES/COMMITTEES			SCHEDULE D		Page No.	of

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.
Use a separate “SCHEDULE D” for each separate account and each separate recipient type.

 New Jersey Gubernatorial Candidates/Committees	 New Jersey Legislative Candidates/Committees
 All Other Candidates/Committees

Committee Name

Account Name

Recipient Name and Address	Election Date		Check			Amount
(Number and Street, City, State, Zip Code)	District or County	No(s)		Date(s)		of each
	or Municipality					Contribution























1. SUBTOTAL (Add all contributions made to each recipient type listed on this page.)

2. TOTAL, THIS RECIPIENT TYPE, THIS PERIOD (Complete this line on the last page used for
each recipient type. Carry forward to Page 2, either Line 15a, Line 15b, or Line 15c, Column A.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 8 of 11 Revised: 02.28.2018

ITEMIZED EXPENDITURES MADE AND INCURRED ON

SCHEDULE E

Page No.

BEHALF OF CANDIDATES/COMMITTEES

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.

Use a separate “SCHEDULE E” for each separate account and each separate recipient type.

 New Jersey Gubernatorial Candidates/Committees

 New Jersey Legislative Candidates/Committees

 All Other Candidates/Committees

 Independent Expenditures

Committee Name

Account Name

Payee Name and Address

Purpose

Amount(s) this Period

Transaction

Check

(Number, Street, City, State and Zip Code)

Incurred/Not Paid

Disbursed

Date(s)

No(s)

ALLOCATION OF EXPENDITURES BENEFITING CANDIDATE(S)/COMMITTEE(S)

Candidate/Committee Name

Election

District or County

Pro-Rated

Date

or Municipality

Amount

Payee Name and Address

Purpose

Amount(s) this Period

Transaction

Check

(Number, Street, City, State and Zip Code)

Incurred/Not Paid

Disbursed

Date(s)

No(s)

ALLOCATION OF EXPENDITURES BENEFITING CANDIDATE(S)/COMMITTEE(S)

Candidate/Committee Name

Election

District or County

Pro-Rated

Date

or Municipality

Amount

1. SUBTOTAL (Add all disbursements made to each recipient type listed on this page.)

2. TOTAL DISBURSEMENTS, THIS PERIOD (Complete this line on the last page used for

each recipient type. Carry forward to Page 2, either Line 16a, Line 16b, or Line 16c,

Column A.)

3. SUBTOTAL (Add all outstanding obligations incurred/not paid, listed on this page.)

4. TOTAL OUTSTANDING OBLIGATIONS INCURRED/NOT PAID (Complete this line on

the last page used. Carry back to Page 10, “Schedule F”, Line 2.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 9 of 11 Revised: 02.28.2018

DEBTS AND OBLIGATIONS OWED BY COMMITTEE		SCHEDULE F		Page No.	of

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.
Use a separate “SCHEDULE F” for each separate account.

Committee Name

Account Name

Creditor Name and Address	Outstanding		Amount	Payments	Outstanding
(Number, Street, City, State, and Zip Code)	Beginning Balance		Incurred	this Period	Balance this
	this Period		this Period		Period


Debt Purpose


Debt Purpose


Debt Purpose


Debt Purpose

SUMMARY OF DEBTS AND OBLIGATIONS

1. TOTAL OUTSTANDING LOANS PLUS INTEREST FROM SCHEDULE B, PAGE 5,
LINE 4

2. TOTAL OUTSTANDING OBLIGATIONS INCURRED/NOT PAID ON BEHALF OF
CANDIDATES/COMMITTEES FROM SCHEDULE E, PAGE 9, LINE 4

3. TOTAL OUTSTANDING OBLIGATIONS, SCHEDULE F
(Complete this line on the last page used.)

4. TOTAL OUTSTANDING DEBTS/OBLIGATIONS OWED BY COMMITTEE
(Add lines 1, 2 and 3. Carry forward to front page, Line 10.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 10 of 11 Revised: 02.28.2018

DEBTS AND OBLIGATIONS OWED TO COMMITTEE			SCHEDULE G		Page No.	of
(Accounts Receivable)

PLEASE TYPE OR PRINT. PHOTOCOPIES MAY BE USED IF ADDITIONAL FORMS ARE NEEDED.
Use a separate “SCHEDULE G” for each separate account.

Committee Name

Account Name

Debtor Name and Address		Balance Due		New Amount	Total Amount	Balance Due
(Number, Street, City, State, and Zip Code)		at beginning		this Period	Received	at Close of
		of this Period			this Period	this Period


Date Debt Incurred	Debt Description


Date Debt Incurred	Debt Description



Date Debt Incurred	Debt Description


Date Debt Incurred	Debt Description


Date Debt Incurred	Debt Description

SUMMARY OF DEBTS AND OBLIGATIONS

1. SUBTOTAL (Add all debts and obligations owed to committee listed on this page.)

2. TOTAL DEBTS AND OBLIGATIONS OWED TO COMMITTEE

(Complete this line on the last page used. Carry forward to front page, Line 8.)

New Jersey Election Law Enforcement Commission

Form R-3 Page 11 of 11 Revised: 02.28.2018

Question	Answer
Form Name	New Jersey Form R 3
Form Length	11 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min 45 sec
Other names	form r3, nj elec, 3 nj elec form, nj form r 3

New Jersey Form R 3 – Fill Out and Use This PDF

New Jersey Form R 3 PDF Details

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