CERTIFICATION OF CONSENT TO SERVICE OF PROCESS
FORM COC-C
AND SUBMISSION TO JURISDICTION IN THE STATE OF
NEW JERSEY - COMMITTEE INFORMATION
NEW JERSEY ELECTION LAW ENFORCEMENT COMMISSION
P.O. Box 185, Trenton, NJ 08625-0185
Phone: (609) 292-8700
Website: www.elec.nj.gov
COMMITTEE 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 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 or other matter brought by the New Jersey Election Law Enforcement Commission to enforce the
provision 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:
Certification
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.
Registration Number
PIN
Signature of Treasurer
Date
Registration Number
PIN
Signature of the person authorized to accept service
Date
(if other than Treasurer)
New Jersey Election Law Enforcement Commission
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Form COC-C Revised: Jan. 2023
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