Municipal Prosecutor Disclosure Statement

Municipal Prosecutor Disclosure Statement
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Section I. Personal Information
First Name: *
Middle:
Last Name: *
Suffix
New Jersey Attorney ID: *
Business Address: *

Street Address

Street Address Line 2

City

Postal / Zip Code
Business Address: *
Bus. Phone No.: *

Area Code Phone Number
Cell Phone No.:

Area Code Phone Number
Email address: *
example@example.com
Spouse:
First Name: *
If you are unmarried, please enter N/A into the First Name and Last Name fields.
Middle:
Last Name: *
Suffix
Section II. Municipal Prosecutor Information
Appointing Governing Body: *
Term of Current Appointment
Begin Date: *

Month Day Year
Date
End Date: *

Month Day Year
Date
Details on Current Appointment Term if Applicable
Holdover? (If the end date of your most recent appointed term of service has passed and you are continuing your service in a holdover capacity, please click ‘Yes.’ Otherwise, please click ‘No.’) *

Yes No
Date Holdover Status Began:

Month Day Year
Date
First Date of First Term of Service: *

Month Day Year
Date
List All Terms of Service:
Name of Municipal Court: *
County Where Municipal Court is Located: *
Address of Municipal Prosecutor's Office: *

Street Address

Street Address Line 2

City

Postal / Zip Code
Municipal Prosecutor's Phone No.:

Area Code Phone Number
Municipal Prosecutor email address: *
example@example.com
No. of Municipal Prosecutors in this Court: *
Are you the Chief Municipal Prosecutor? *

Yes No
Are you serving as a Municipal Prosecutor on an acting, temporary, or substitute basis? *

Yes No
If yes to the above question, on what basis are you serving?
What are the dates of the term that you are serving as an acting, temporary or substitute basis?

Month Day Year
From Date
Month Day Year
To Date
Are you a Municipal Prosecutor in other municipalities? If yes, list all municipalities in which you prosecute. *

Yes No
List all municipalities in which you prosecute:
Section III. Employment Information
Do you currently hold another Local Government position? *

Yes No
A. Local Government Officer Information:
Do you currently hold another State Government position? *

Yes No
B. State Government Officer Information:
Are you an elected official? *

Yes No
If yes to the above, please specify (assemblyperson, state senator, other)
Section IV. Financial Information
Provide the following information for yourself and members of your immediate family for the prior calendar year. If none, please indicate NONE in the space provided.
A. List the name and address of each source of income, earned and unearned, which you received in excess of $2,000. If a publicly traded security is the source of income, the security need not be reported unless you or a member of your immediate family has an interest in the business organization. *
B. List the name and address of each source of fees and honorariums having an aggregate amount exceeding $250 received from any single source for personal appearances, speeches, or writing. *
C. List the name and address of each source of gifts, reimbursements or prepaid expenses having an aggregate value exceeding $400 from any single source. *
D. List the name and address of all business organizations in which an interest was held. *
E. List the address and a brief description of all real property in the State of New Jersey in which an interest was held. *
Section V. Certification & Online Filing Process
I hereby certify that this Municipal Prosecutor Disclosure Statement contains no willful misstatement of fact or omission of material fact and constitutes a full disclosure with respect to all matters required by New Jersey Attorney General Directive 2019-7, to the best of my knowledge. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to fines and possible disciplinary action.
Date: *

Month Day Year
Date
Name: *
I further certify that I intend my electronic signature on this statement to be the legally binding equivalent of my traditional handwritten signature.
Should be Empty: