PDF document
- 1 -
                                                       POWER OF ATTORNEY
 KNOW ALL MEN BY THESE PRESENTS:                        

 THAT                                                  Employer Registration Number                                                 __ having its principal office

 at                                                     does hereby appoint

 its true and lawful attorney in fact with full power and authority to represent the said                                              before the NEW JERSEY
 DIVISION OF EMPLOYER ACCOUNTS  until further notice, to wit: All matters affecting quarterly contributions reports, experience rating and 
 claims for benefits.

 THIS AUTHORIZATION CANCELS AND SUPERSEDES ALL PRIOR POWERS OF ATTORNEY.

 IN WITNESS WHEREOF, the said                                    has caused this instrument to be signed, sealed and acknowledged by its duly

 authorized qualified officer this   day of

,
                                                                                                                    (Name of Company)

 CORPORATE SEAL                                                                           By
                                                                                                        (Signature of Authorized Officer)

                                                                                                        (Name and Title of Authorized Officer)
 AFFIDAVIT:

 I                          being duly sworn depose and say that I hold the office of                               , in the                      I Employer

 Registration Number                 having its principal office at                                     and am fully authorized on behalf of such

 company to grant the powers stated in said Power of Attorney to                                        as the true and lawful attorney in fact with power

 and authority to represent                             before the NEW JERSEY DIVISION OF EMPLOYER ACCOUNTS without

 first obtaining the direction and approval of the Board of Directors of

           .
                                                                                                        (Signature of Authorized Officer)

 Be it known that on this          day of                        I           before me                                                 notary public for this State

 of        residing in the county of                             , duly commissioned and sworn and by law authorized to administer oaths and

 affirmations, personally appeared                               and being sworn by me did depose and say that the contents in the foregoing

 affidavit are true and correct.

                                                                                                                    Notary Public
                                     (NOTARY SEAL)                                                Notary Expiration:

 ACCEPTANCE:

 I                                   being a duly qualified officer of                                              hereby accept on behalf of the

 said corporation the power herein described granted by

                                                                                         Signature     :

                                                                                           Title:

                                                                                                   Authorized Agent Reg No.: ___________________________________________ 






PDF file checksum: 2830201796

(Plugin #1/9.12/13.0)