page 1 of 1 New Jersey Attorney Designation of Clerk of the Supreme Court as Agent Upon Whom Service of Process May Be Made (Rule 1:21-1(a)(2)) An attorney who is not domiciled in this State and does not maintain a fixed physical location for the practice of law 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 the purposes set forth in subsection (a)(1) of this rule [i.e., for all actions, including disciplinary actions, that may arise out of the practice of law and activities relatedPlease Provide All Requested Information First Name: Middle Name: Last Name: Date of Admission to New Jersey Bar: N.J. Attorney ID: Designated Location [Rule 1:21-1(a)(1) requires attorneys to 223designate one or more fixed physical locations where client files and the attorney222s business and financial records may be inspected on short notice by duly authorized regulatory authorities, where mail or hand-deliveries may be made and promptly received, and where process may be Address: Municipality : State: Zip Code: Telephone: E - mail: Check if this is a residence Residence Address (if not provided above): Municipality : State: Zip Code: E - mail: ATTORNEY222S CERTIFICATIONS & DESIGNATION: Check this box and sign below if you are admitted to the New Jersey bar and meet all qualifications for the practice of law but are not domiciled in New Jersey and do not maintain a fixed physical location for the practice of law in New Jersey. I certify that I meet all qualifications for the practice of law in New Jersey Signature: Submit the original of this form to: Clerk of the Supreme Court of New Jersey Hughes Justice Complex, P.O. Box 970 Trenton, NJ 08625-0970If you have questions about this form, call (609) or e-mail supremect.mailbox@. Revised: 02/2/201, CN: 11712 Supreme Court of New Jersey American LegalNet, Inc. www.FormsWorkFlow.com