Affidavit of Service, World Trade Center matter, undated

NYC 9/11 Public Portal Document

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,AFFMAVIT OF SERVICE

STATE OF NEW YORK, COUNTY OF t4F W The undersigned being duly swains, deposes and says: T e is n party to th and is over 18 years of age. That on ` l/ l L~?!I~/5/ ) deponent the within ORDER on the respondent named therein 1. Individual personal service O by delivering a true copy to said respondent personally 2. Individual substitued service /' lby delivering a true copy to REVS 37AMES MC GRAYV w

a person of suitable age and discretion. Said premises is respondent's actual place of business-dwelling house or usual place of abode within the state. 3. Corporation ❑ by delivering a true copy to at said coporation. (Poaitiaa) 4. Delivery to employee at premises ❑At AM/P.M on at I attempted to personally serve the herein ORDER on the respondent named herein but was unable to do because: ❑ having attempted entry to the premises, I found the premises locked and no one responded to any bells, knocks, or calls; ❑ having entered the premises and having identified myself I was: ❑ advised by that the respondent was not then present (Name) ❑ unable to secure identification of the person(s) present; O advised by that no officer, director, managing (Name) agent or general agent of the respondent was present; ❑ service could not be made because

Thereupon. I delivered a copy of the herein ORDER to whom I believe to be an employee of respondeent at the premises because: OEmployee so identified ❑Employee was performing work himself/herself consistent with being employed by the respondent

Description of individual - (this must be completed for all types of service except ooporation) Deponent describes the individual as follows: 'male [white skin ❑Black hair O14-20 yrs O Under 5' O Under 100 lbs ❑ female ❑ black skin ❑Brown hair O21-35 ❑ 5'0"-5'3" O101-130 ❑ yellow skin O Blond hair O36-50 O 5'4"-S8" ❑ 131 - 160 ❑ brown skin ❑ Red hair Q:5l-65 X5'9" -6"0" O161-200 ❑ red skin 9Gray hair ❑ Over 65 O Over 6' ]Over 200 ❑ White hair ❑ Balding Other identifying characteristic:

5. Service by Mail DBy mailing a true copy to respondent by depositing or causing to be deposited the same, in a post paid wrapper, in a post office station regularly maintained by the U.S. Postal Service.

SWORN TO BEFOREME ON THE SI AT[IRE DAY OF 19_ AZT FEi4ECis PRINT NAME

DERTA - White RESPONDENT - Yellow LEGAL - Pink

NYC-WT C 000092987