CERTIFICATION OF CONSENT TO
FORM L-3
SERVICE OF PROCESS AND
Reporting for Calendar Year 20
SUBMISSION TO JURISDICTION IN
THE STATE OF NEW JERSEY
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION
P.O. Box 185, Trenton, NJ 08625-0185
FOR STATE USE ONLY
Phone: (609) 292-8700
Website: www.elec.nj.gov
Amendment
1.
, hereby
consents to service of process within the State of New Jersey and jurisdiction in the Courts of the State of New Jersey or in the Office of Administrative Law of the State of New Jersey for any case brought by the New Jersey Election Law Enforcement Commission to enforce the provisions of N.J.S.A. 52:13C-18 et seq., or the regulations promulgated thereunder.
2. The name and address of the person or entity within the State of New Jersey authorized to accept service:
- or -
The out-of-state name and mailing address of the person or entity authorized to accept service:
I hereby certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I may be subject to punishment.
To be signed by an authorized person of the entity listed in Item #1.
Name of Authorized Person
Registration Number
PIN
Title
Date
Authorized Signature
To be acknowledged by the person authorized to accept service listed in Item #2.
Name of Authorized Person
Registration Number
PIN
Title
Signature of Person Authorized to Accept Service
Date
New Jersey Election Law Enforcement Commission
Page 1 of 1
sForm L-3 Revised Mar. 2023
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Confirmation
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Required; Format : Date - mm/dd/yyyy
Format : Date - mm/dd/yyyy
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