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Non-Participating Manufacturer Certification Of Appointment Of Agent For Service Of Process NPM-A - New Jersey
| Non-Participating Manufacturer Certification Of Appointment Of Agent For Service Of Process Form. This is a New Jersey form and can be used in Tobacco Enforcement Office Of The Attorney General Statewide . |
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State of New Jersey Non-Participating Manufacturer Certification of Appointment of Agent for Service of Process Please Review Instructions Prior to Completion NPM-A Part 1: Certification Year and Type of Certification Complete a separate form for each certification year for which you are certifying. 2013 certification year is for 2012 sales (check one) Certification Year: 2013 Annual Other: ______ Supplemental Type of Certification: (check one) Part 2: M anufacturer Identification Company Name Mailing Address City Phone Name and Title of Person Completing this Form Email Address State Fax Initial Zip Code FEIN Country Part 3: Manufacturer Status (Check one) 9 9 The NPM certifies that it is registered to do business in New Jersey. (Attach certification from New Jersey Secretary of State.) The NPM certifies that it is a non-resident or foreign NPM that has not registered to do business in New Jersey, and hereby certifies that it has appointed an agent, located within the State of New Jersey, to receive service of process on its behalf. (Complete Part 4 and attach proof of appointment and availability of Agent.) Part 4: Agent Appointed for Service of Process Company Physical Address City Mailing Address City Phone Availability of Agent (hours of business) Part 5: Manufacturer Certification Under penalties of perjury, I state that, to the best of my knowledge, all of the information contained in this Certification and any attached documents are true and accurate. This document must be signed and dated by an authorized notary public. Contact Name State Zip Code State Fax Zip Code E-Mail NPM Authorized Designee (Print Name) Title Signature of NPM Authorized Designee Date Subscribed and sworn to before me this date: Signature of Notary Public County Commission Expires American LegalNet, Inc. www.FormsWorkFlow.com State of New Jersey Non-Participating Manufacturer Certification of Appointment of Agent for Service of Process NPM-A Instructions General Information Who must file this Certification? Any Non-Participating Manufacturer (NPM) whose cigarettes or roll-your-own tobacco (RYO) were sold in New Jersey during the preceding calendar year or who intends for its brands to be listed as compliant in the New Jersey Directory of Compliant NPMs. Specific Instructions Part 1: Certification Year and Type of Certification · Mark appropriate certification year. You must submit a · · separate certification for each year you are certifying. If "Other" is checked, enter certification year for which certification is being provided. Mark whether this is an initial (manufacturer is not currently listed on the New Jersey Directory), annual (due April 15, 2013 for 2012 sales) or supplemental (change of information provided to the Attorney General) certification. Who Must Appoint an Agent for Service of Process? · Non-resident (out-of-state) and foreign NPM s who are not registered to do business in New Jersey are required to continually engage, without interruption, an agent in this State for acceptance of service of process. W here an NPM's products are sold in New Jersey and the NPM fails to appoint an agent as required by N.J.S.A. 52:4D-1 et. seq., the NPM shall be deemed to appoint the New Jersey Secretary of State as the agent on whom process may be served on its behalf. However, such appointment will not satisfy the condition precedent for having its brand families listed in the Directory of Compliant NPMs. Part 2: Manufacturer Identification Provide your company name, address, and phone, fax, FEIN numbers, person filling out certification and email. · Part 3: Manufacturer Status · If you are registered to do business in New Jersey, ATTACH CERTIFICATION FROM NEW JERSEY DIVISION OF REVENUE, BUSINESS REGISTRATION and complete Part 5. If you are not registered to do business in New Jersey you must appoint an agent for service of process who is located within New Jersey. ATTACH CURRENT PROOF OF APPOINTM ENT AND AVAILABILITY OF AGENT. · When is this Certification due? The annual certification must be filed with the Attorney General no later than April 15 of each year for the preceding year's sales. An initial certification may be filed at any time. · Updates If the NPM terminates the authority of an agent, the NPM shall notify the Attorney General at least 30 calendar days prior to the termination and provide proof of the appointment of a new agent at least 5 calendar days prior to the termination. If the agent terminates an agency appointment, the NPM shall notify the Attorney General of the termination within 5 calendar days of the termination and shall include proof of the appointment of a new agent. Part 4: Agent Appointed for Service of Process · Provide contact name and company of Agent appointed for service of process. Provide their physical (street) address as well as mailing address, phone and fax numbers, e-mail address and availability. Availability of Agent: normal business hours during which the agent is available at the address provided for the purpose of service of process. · Part 5: Manufacturer Certification The authorized designee executing the certification must be an officer, principal, director or other authorized representative of the manufacturer. The authorized designee's name and title must be legibly printed and the signature must be notarized. For Additional Information Phone DAG Glenn T. Graham at (973) 648-7457 or visit: Mail original document, with attachments to: New Jersey Office of the Attorney General Division of Law 124 Halsey Street P.O. Box 45029 Newark, New Jersey 07101 ATTN: DAG Glenn T. Graham http://www.nj.gov/oag/oag_tobacco.html Mail original document, with attachments to: Rev. 2/13/2013 American LegalNet, Inc. www.FormsWorkFlow.com
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