Supreme Court of New Jersey NEW JERSEY ATTORNEY DESIGNATION OF CLERK AS AGENT FOR SERVICE OF PROCESS An attorney who is not domiciled in this State and does not have a bona fide office in this State, but who meets all the qualifications for the practice of law set forth herein must designate the Clerk of the Supreme Court as agent upon whom service of process may be made for all actions, including disciplinary actions, that may arise out of the practice of law and activities related thereto, in the event that service cannot otherwise be effectuated pursuant to the appropriate Rules of Court. The designation of the Clerk as agent shall be made on a form approved by the Supreme Court. [Excerpt from first paragraph of Rule 1:21-1(a)] [N.J. ATTORNEY ID: ___________________ (To be designated by Clerk's Office)] ATTORNEY MUST PROVIDE ALL REQUESTED INFORMATION: FIRST NAME: _____________________________________________ MIDDLE NAME: _____________________________________________ LAST NAME: _____________________________________________ SUFFIX (if applicable): _______________ BAR ADMISSION (List Date of Admission to New Jersey Bar) __________________________ BONA FIDE OFFICE FOR THE PRACTICE OF LAW: Firm Name ___________________________________________________________________ Address ___________________________________________________________________ ___________________________________________________________________ Municipality _____________________________ State ____________ Zip Code ____________ Telephone ___________________________________________________________________ RESIDENCE: Address ___________________________________________________________________ Municipality _____________________________ State ____________ Zip Code ____________ Telephone ___________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com ATTORNEY'S CERTIFICATIONS & DESIGNATION:  If you have a plenary admission to the Bar of the New Jersey and otherwise meet all the qualifications for the practice of law in this State but are neither domiciled in New Jersey nor maintain a bona fide office in this State, please enter a check in the box at the beginning of this paragraph and sign the certification below. R. 1:21-1(a). I hereby certify that I meet all the qualifications for the practice of law in New Jersey and designate the Clerk of the Supreme Court as agent on whom service of process may be made in all actions, including disciplinary actions, that may arise out of my practice of law in New Jersey and related activities if that service cannot otherwise be effectuated pursuant to the appropriate Rules of Court. I 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 am subject to punishment. DATE: (Signature) ______________________________________________ (Print Name) File the original of this form with: Clerk of the Supreme Court of New Jersey Hughes Justice Complex PO Box 970 Trenton, NJ 08625-0970 If you have any questions regarding the completion of this form, you may send an email to or telephone (609) 984-4371. Page 2 of 2 AGNT DF Revised March 1, 2006 American LegalNet, Inc. www.FormsWorkflow.com