CERTIFICATION OF CONSENT TO SERVICE OF PROCESSFORM COC-CAND SUBMISSION TO JURISDICTION IN THE STATE OFNEW JERSEY - COMMITTEE INFORMATIONNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSIONP.O. Box 185, Trenton, NJ 08625-0185(609) 292-8700 or Toll Free Within NJ 1-888-313-ELEC (3532)www.elec.nj.govCOMMITTEE INFORMATION(Name, Number and Street, City, State and Zip Code), hereby(Name of Treasurer)consents to accept service of process on behalf of the above-named committee and on behalf of myself within the State ofNew Jersey and jurisdiction in the courts of the State of New Jersey or in the Office of Administrative Law of the State ofNew Jersey for any case or other matter brought by the New Jersey Election Law Enforcement Commission to enforce theprovision of N.J.S.A. 19:44A-1 et seq., or the regulations promulgated thereunder.The name and resident address of the person or entity within the State of New Jersey authorized to accept service on behalf of the above-named committee and on behalf of myself is:- or -The out-of-state mailing address of the person or entity authorized to accept service by regular U.S. mail on behalf of the above-named committee and on behalf of myself is:CertificationI 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.Registration NumberPINSignature of TreasurerDateRegistration NumberPINSignature of the person authorized to accept serviceDate(if other than Treasurer)New Jersey Election Law Enforcement CommissionPage 1 of 1Form COC-C Revised: Jun. 2021
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