Green Party of New Jersey

the choice for the 2007 New Jersey Legislative elections

Fill out and check ALL information as required by law.  Only United States Citizens and Permanent Residents may contribute to any U.S. political committee.

Contributions:  Please make check payable to:  "Green Party of New Jersey", and you must include the following information as required by New Jersey election campaign law.  Checks or other negotiable instruments are required for all donations $200.00 and above.

*Name:  ____________________________________________________________________________

*Address:  ________________________________City/State:  ________________________Zip:  ______

Telephone:  ________________________________Email:  ____________________________________

Signature:  __________________________________*Amount of Donation:  $______________________

*Occupation:  ____________________________________*Retired:  ________*Homemaker:  _________

   not title                   (do not write “self-employed”)

*Employer:  __________________________________________________________________________

*Employer Address:  ________________________________*City/State:  ______________*Zip:  _______

CHECK BOX  I am at least 18 years old.  CHECK BOX  I have read the information above and below and agree.

**  A service charge applies to bounced or returned checks.  **

If the Amount of the Donation is $300.00 or above or you plan to give an aggregate during the year of $300.00 and above with the limit of $7,200 for this political party required to form as a “Continuing Political Committee” (CPC) under New Jersey law, the above marked (*) information as required by New Jersey election laws will be reported.  For donations below $300.00, the political party CPC is required to keep this in our records.

The maximum amount of any contribution for the "Green Party of New Jersey" is $7,200.  Partners to civil marriage or civil union may also give up to $7,200, providing their donation is made independently from funds over which they control.

Federal law requires political committees to use their best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.  Federal law prohibits contributions to a political committee from:

· the general treasury funds of corporations, labor organizations or national banks (including corporate credit cards);

· any person contributing another person's funds or a person who is a federal contractor;

· foreign nationals who lack permanent resident status; and

· government contractors.

Paid for by "Green Party of New Jersey", P.O. Box 9802, Trenton, NJ 08650-9802  ●  609-933-0526  ●  Treasurer@gpnj.org

Thank you for your donation, it is greatly appreciated!