GOVERNMENTAL AFFAIRS AGENTFORM NTNOTICE OF TERMINATIONFOR STATE USE ONLYNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSIONP.O. Box 185, Trenton, NJ 08625-0185Phone: (609) 292-8700Website: www.elec.nj.govName of Governmental Affairs AgentFirst NameLast NameBadge Number*(Area Code) Telephone NumberBusiness NameBusiness AddressCityStateZip CodeEntity listed below have ceased.Name of Represented EntityAddressCityZip codeStateOREffective Date of TerminationOREffective Date of TerminationRegistrationNumberPINSignature of Governmental Affairs AgentDateNew Jersey Election Law Enforcement CommissionForm NT Revised: Mar. 2023*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.ConfirmationRequired;Required; Format : PhoneRequired;Required;Required; Format : Zipcode Format : Zipcode Format : Date - mm/dd/yyyy Format : Date - mm/dd/yyyyRequired;Required;Required; Format : Date - mm/dd/yyyyNotice is hereby given that lobbying activities as a Governmental Affairs Agent (GAA) on behalf of the Represented Check here if the Represented Entity should be terminated for all GAAs employed by the Business Name listed on the form.Check here if the termination applies to specific GAAs. List the names of the GAAs for which the above Represented Entity should be terminated:Notice is hereby given that all my activities as a Governmental Affairs Agent are terminated and, my badge will be forwarded to the Commission.Check here if terminating association with the above Business Name.Check here if terminating all activities as a GAA. AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Required Field