~ REPORT OF CONTRIBUTIONS AND REPORT (CHECK ONE)

FORM R-1 EXPENDITURES g.-29 - DAY PRE-ELECTION

NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION 11 - DAY PRE-ELECTION
POBox 185, Trenton, NJ 08625-0185 o 20 - DAY POST-ELECTION
(609) 292-8700 or ToU Free Wlthm NJ 1-888-313-ELEC (3532) D Apr 15,
Web Site http Ilwww elec stale nJ usl o July 15,
CANDIDATE OR COMMITTEE NAME
Z;I""'~ '/J-r- --I() ~ p Ie-c.+ 1-/,,(1/ <5-/v /, h,., (I v. D Oct 15,
o Jan 15,
STREET ADDRESS Po 0# / /
a ,91 Amendment Yes D N~
CITY O. V STATE Izo~r.>f For State Use Only
t""ICtl t f/) ELEC RECEIVED
COUNTY IJ. ELECit::jDISTRICT OR MUNICIPALITY
/~'" /rl_i1'1-l MAY 1 0 201D
POLlTI~ARTY, IF ANY OFFIC~I"UGHT I I
eY(r!._. f cc>«,
ELECTION DATE ELECTION TYPE ~PRIMARY o MUNICIPAL D GENERAL
Tl.-rL{' ;]01 () (CHECK ONE) RUN·OFF D SCHOOL D SPECIAL
SUMM~Y TABLES DO NOT ATTEMPT TO COMPLETE TABLES I AND II UNTIL
APPROPRIATE SCHEDULES HAVE BEEN COMPLETED
TABLE I RECEIPTS THIS REPORT CUMULATIVE TO
DATE
1 MONETARY CONTRIBUTIONS OF $300 OR LESS $ Q_ $ Jell, (" \)
2 MONETARY CONTRIBUTIONS IN EXCESS OF $300 AND ALL CURRENCY $ () $ 'SIJ 5' l' v
CONTRIBUTIONS [Schedule AJ
3 IN·KIND CONTRIBUTIONS OF $300 OR LESS $ 0 $ I «. J S
4 IN·KIND CONTRIBUTIONS IN EXCESS OF $300 [Schedule B] s $
5 LOANS RECEIVED IN EXCESS OF $300 AND ALL CURRENCY LOANS $ $
[Schedule C] j331 . J 5
6 SUB TOTAL (ADO LINES 1 THRU 5) $ 0 $
7 REFUND OF EXCESSIVE CONTRIBUTIONS [Adjustment Schedule] (-) $ $
8 TOTAL CONTRIBUTIONS s D $ 'Z?'31 )5
9 ADD FUNDS TRANSFERRED FROM PRIOR CAMPAIGN (+) $ $
10 TOTAL RECEIPTS (ADD LINE 8 + LINE 9) $ r) $,<~3) I J S
TABLE II. EXPENDITURES
1 DISBURSEMENTS -CAMPAIGN EXPENSES [Schedule 1{DlJ $ n $ rJ
2 DISBURSEMENTS - OTHER [Schedule 2(D)J $ () $ (11 .. IS
3 DISBURSEMENTS· CONTRIBUTIONS MADE TO OTHER $ rJ $ 3/n C0
CANDIDATES/COMMITTEES [Schedule 3(0)]
4 CONTRIBUTIONS MADE ON BEHALF OF OTHERS $ $
[Pro Rata Amount Schedules 1 (D) anc 2(D}}
5 IN-KIND CONTRIBUTIONS OF $300 OR lESS (TABLE I, LINE 3) $ D $ (0(. dS
6 IN·KIND CONTRIBUTIONS IN EXCESS OF $300 (TABLE I, LINE 4) $ $
7 SUB TOTAL (ADD LINES 1 THRU 6) $ 0 $<330. C o
8 REFUNDED DISBURSEMENTS [Schedule Fl (-) $ f!Y $
9 TOTAL EXPENDITURES (LINE 7 MINUS LINE 8) $ CJ $$330. C/O New Jersey Election laW EnfOiCement CommIssion January 2005

FORMR·t

SCHEDULE A

Monetary Contributions In Excess of $300 and All Currency Contributions

CONTRIBUTOR NAME EMPLOYER NAME
fJ (,
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

I~HECK IF AGGREGATE AMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
CURRENCY 0 $ $
OCCUPATION
CONTRIBUTOR NAME EMPLOYER NAME
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

ICHECK IF AGGREGATE AMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
CURRENCY 0 $ $
OCCUPATION
CONTRIBUTOR NAME EMPLOYER NAME
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

ICHECK IF AGGREGATE AMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
CURRENCY 0 $ $
OCCUPATION
CONTRIBUTOR NAME EMPLOYER NAME
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

ICHECK IF AGGREGATE AMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
CURRENCY 0 $ $
OCCUPATION
CONTRIBUTOR NAME EMPLOYER NAME
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

I~HECK IF 0 I AGGREGATE AMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
CURRENCY $ $
OCCUPATION
(COMPLETE THIS LINE FOR EVERY PAGE USED) TOTAL, THIS PAGE $
(COMPLETE THIS LINE FOR LAST PAGE USED) GRANO TOTAL $ ()
....... New Jersey EledJOn Law Enforcemenl Commission, January, 2005

2

FORM R-l

SCHEDULE 8

In-Kind Contnbunons In Excess of $300

CONTRIBUTOR NAME )J/~ EMPLOYER NAME
CONTRIBUTOR ADDRESS' EMPLOYER ADDRESS

I~GGREGATE AMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
$
OCCUPATION
DESCRIPTION OF IN-KIND CONTRIBUTION(S)
CONTRIBUTOR NAME EMPLOYER NAME
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

I:GGREGATE AMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
$
OCCUPATION
DESCRIPTION OF IN-KIND CONTRIBUTION(S)
CONTRIBUTOR NAME EMPLOYER NAME
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

I~GGREGATEAMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
$
OCCUPATION
DESCRIPTION OF IN-KIND CONTRIBUTION(S)
CONTRIBUTOR NAME EMPLOYER NAME
CONTRIBUTOR ADDRESS EMPLOYER ADDRESS

I:GGREGATEAMOUNT DATE(S) RECEIVED AMOUNT(S) RECEIVED THIS PERIOD
$
OCCUPATION
DESCRIPTION OF IN-KIND CONTRIBUTION(S)
(COMPLETE THIS LINE FOR EVERY PAGE USED) TOTAL, THIS PAGE $
(COMPLETE THIS LINE FOR LAST PAGE USED) GRAND TOTAL $ () New Jersey Elecbon Law Enforcement Commission, January, 2005

3

FORM R-1

SCHEDULE C

Loans Received in Excess of $300 and All Currency Loans

LENDER NAME EMPLOYER NAME
jj I P,
LENDER ADDRESS EMPLOYER ADDRESS

OCCUPATION
CO-SIGNER NAME EMPLOYER NAME
CO-SIGNER ADDRESS EMPLOYER ADDRESS

OCCUPATION AMOUNT(S) RECEIVED THIS PERIOD
$
DATE(S) RECEIVED AGGREGATE AMOUNT CHECK IF
CURRENCY 0
$
LENDER NAME EMPLOYER NAME
LENDER ADDRESS EMPLOYER ADDRESS

OCCUPATION
CO-SIGNER NAME EMPLOYER NAME
CO-SIGNER ADDRESS EMPLOYER ADDRESS

OCCUPATION AMOUNT(S) RECEIVED THIS PERIOD
$
DATE(S) RECEIVED AGGREGATE AMOUNT CHECK IF
CURRENCY 0
$
TOTAL AMOUNT OF LOANS RECEIVED THIS REPORT PERIOD D
$ New Jersey Election Law Enforcement Commission, January 2005

FORMR-1

4

ADJUSTMENT SCHEDULE Refund of Excessive Contributions

PAYMENT DATE CHECK NO PAYEE NAME AND ADDRESS REFUNDED AMOUNT
$
}ill)
(COMPLETE THIS LINE FOR EVERY PAGE USED) TOTAL, THIS PAGE $
(COMPLETE THIS LINE FOR LAST PAGE USED) GRAND TOTAL $ 0 New Jersey ElectJon Law Enforcement CommISsion January 2005

5

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SCHEDULE E Outstanding Obligations

Date Incurred Creditor's Name Address Description Amount
$
lv/Pi
TOTAL $
OUTSTANDING
OBLIGATIONS SCHEDULE F

Refunded Disbursements

Date Full Name Address Descrrption Amount
$
A1;h
SCHEDULE F TOTAL $ D NeW JelSey Election Law Enforcement CommISSion Janua!),,2005

9

FORMR 1

SCHEDULE G Recipients of In-Kind Contributions

,
NAME OF RECIPIENT CANDIDATE/COMMITTEE N/A
MAILING ADDRESS I I
OFFICE SOUGHT ELECTION DISTRICT OR MUNICIPALITY
CHECK NUMBER PAYMENT DATE AMOUNT
$
NAME OF RECIPIENT CANDIDATE/COMMITTEE
MAILING ADDRESS
OFFICE SOUGHT ELECTION DISTRICT OR MUNICIPALITY
CHECK NUMBER PAYMENT DATE AMOUNT
$
NAME OF RECIPIENT CANDIDATE/COMMITTEE
MAILING ADDRESS
OFFICE SOUGHT ELECTION DISTRICT OR MUNICIPALITY
CHECK NUMBER PAYMENT DATE AMOUNT
$
NAME OF RECIPIENT CANDIDATE/COMMITTEE
MAILING ADDRESS
OFFICE SOUGHT ELECTION DISTRICT OR MUNICIPALITY
CHECK NUMBER PAYMENT DATE AMOUNT
$
NAME OF RECIPIENT CANDIDATE/COMMITTEE
MAILING ADDRESS
OFFICE SOUGHT ELECTION DISTRICT OR MUNICIPALITY
CHECK NUMBER PAYMENT DATE :MOb New Jersey Elecbon Law Enforcement Commission, January 2005

10

FORM R-1

•

STATEMENT OF CAMPAIGN DEPOSITORY AND CAMPAIGN TREASURER
Openmg Balance. this report \.l 'J
(Insert closing balance of last report, or, If this IS the first report filed by this entity for this election, $
Insert zero)
Funds Transferred from Prior Campaign $
Deposits (Include Interest) $

Disbursements (Include bank charges) _$_
Closing Balance, this RepOB $ l J S
I
~o(/(Vr 5 II t1 ~~"'/fk fu Cr. I/~(I f.t.r {IC\
NAME 0 BANK OR DEPOSITORY ~/OUNT NUMBER (}7();)~ NAME OF ACCOU~T
J(d We. st; '"'~-f.;" 4t ("I (,/11 ;V )
fl.! (}o de-1-k , (t ADDRESS OF BANK OR DEPOSITORY
a Vt./"f-Z_
NAME OF TREASURER Ave 0",<, f f1{j "TELEPHONE NUMBER (DAY)
i w.L E. iUlr.Lt:.CJ c Af"'.)%'
I ADDRESS OF TREA~ER vt/l

CERTIFICATION

ved conform with the hrmtatrons

PRINT FULL NAME(CNDIDATE)

SIGNATURE (CANDIDATE)

bATE

PRINT FULL NAME (CANDIDATE)

PRINT FULL NAME (CANDIDATE)

~~~~--~~~~~--

PRINT FULL NAME (TREASURER)

Treasurers for Gubernatorial and Legislative candidates are required to receive training With the New Jersey Election Law

Enforcement Commission Check here 0 If you have completed the tralntng and enter your Treasurer Trammq 10# _

DECLARATION OF FINAL REPORT

If tlus IS the final report, sign applicable Declaration below as well as Certification above Chapter 65 of the Laws of 1993 requires that all filing entities continue to file reports With the Commission until all campaiqn business IS wound up and the fund IS dissolved

D I certify that all contributions or other monies received by tlus election fund have been disbursed, that there are no outstanding loans or other obligations, and that the election fund has wound up ItS busmess and has been dissolved

SIGNATURE (CANDIDATE)

DATE

PRINT FULL NAME (CANDIDATE)

bATE

SIGNATURE (CANDIDATE)

PRINT FULL NAME (CANDIDATE)

DATE

PRINT FULL NAME (CANDIDATE)

SIGNATURE (CANDIDATE)

bATE

PRINT FULL NAME (TREASURER)

SIGNATURE (TREASURER)

New Jersey Elacion Law Enforcement CommiSSion January 2005 11

'Leave tms neld blank If your telephone number IS unllstad Pursuant to J::LL§.e. 47 lA 1 1 an unlisted telephone number Is not a publiC record and must not be prOVided on till. form

FORMR-1