CERTIFICATION OF CONSENT TOFORM L-3SERVICE OF PROCESS ANDReporting for Calendar Year 20SUBMISSION TO JURISDICTION INTHE STATE OF NEW JERSEYNEW JERSEY ELECTION LAW ENFORCEMENT COMMISSIONP.O. Box 185, Trenton, NJ 08625-0185FOR STATE USE ONLY(609) 292-8700 or Toll Free Within NJ 1-888-313-ELEC (3532)Website: www.elec.state.nj.usAmendment1., herebyconsents 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 PersonRegistration NumberPINTitleDateAuthorized SignatureTo be acknowledged by the person authorized to accept service listed in Item #2.Name of Authorized PersonRegistration NumberPINTitleSignature of Person Authorized to Accept ServiceDateNew Jersey Election Law Enforcement CommissionPage 1 of 1sForm L-3 Revised Jan. 2016
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