FORM C-1

SUPPLEMENTAL CONTRIBUTOR INFORMATION

ELEC Received
Oct 28, 2018
9:42 AM

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)
Website: www.elec.nj.gov

Amendment

CONTRIBUTIONS REPORT TYPE (Select One)
Committee spending under the R-1 reporting threshold (A-1 or A-2 filers etc.) who received a contribution
in excess of $ 300 in the aggregate from one source in the election, or any currency (cash) contributions.
Committee receiving a contribution in excess of $ 1,600 in the aggregate from one source starting with the
13th day before the election up to, and including the day of the election (48-Hour Notice).
SECTION I. CANDIDATE, JOINT CANDIDATES, OR POLITICAL COMMITTEE INFORMATION
Candidate(s) Name
THOS SHIPLEY
Committee Name
FRIENDS OF THOS SHIPLEY FOR COUNCIL
Street Address
824 LARCH STREET

Office Sought
COUNCIL OR MUNICIPAL OFFICE

City
ROSELLE PARK

State
NJ

Election Type:
(Select One)

*(Area Code) Day Telephone

Zip Code
07204

Primary

May Municipal

Fire District

General

Run-Off

Special

County
UNION COUNTY

*(Area Code) Evening Telephone
Election Date
11/06/2018

Legal Name of Election District or Municipality
ROSELLE PARK BOROUGH

Political Party
REPUBLICAN

SECTION II. CONTRIBUTION INFORMATION (Receipt Types: A = Currency or Check, B = In-Kind, C = Loan)
Date Received
Contributor Name
10/16/2018
ROSELLE PARK REPUBLICAN MUNICIPAL COMMITTEE
Address (Number and Street, City, State, Zip Code)
46C COLFAX MANOR
Occupation (If Individual)

Aggregate Amount
$1,000.00
Receipt
Type: A

Check if
Currency

Amount
$1,000.00

Description, if In-Kind Contribution

Employer Name and Mailing Address (If Individual)
Date Received

Contributor Name

Address (Number and Street, City, State, Zip Code)
Occupation (If Individual)

Aggregate Amount
Receipt
Type:

Check if
Currency

Amount

Description, if In-Kind Contribution

Employer Name and Mailing Address (If Individual)
Date Received

Contributor Name

Address (Number and Street, City, State, Zip Code)
Occupation (If Individual)

Aggregate Amount
Receipt
Type:

Check if
Currency

Amount

Description, if In-Kind Contribution

Employer Name and Mailing Address (If Individual)

Grand Total: $1,000.00
Registration Number

**********

PIN

******

Candidate or Treasurer

THOS SHIPLEY

Date

10/28/2018

*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.

New Jersey Election Law Enforcement Commission

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sForm C-1 Revised Jan. 2017