NYC 9/11 Public Portal Document
AFFIDAVIT OF SERVICE
STATE OF NEW YORK, COUNTY OF — M A N H
The undersigned being duly sworn, deposes and says:
The deponent is not a party to the action and is over 18 years of age, (1
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deponent served the within Notice of Violation and hearing on
the respondent named therein.
1. individual; personal service
❑ by delivering a true copy to said respondent
personally.
2. Individual; substituted service
❑ by delivering a true copy to
a person of suitable age and discretion. Said premises is
Ing house or usual place of abode within the state. respondent's actual place of business-dwell-
3. Corporation
QI by delivering a true copy to LAwR6N64 ANC, . ELI 'bF RetALr4 C
nrS 'DnLyGJdP
poertlon at said corporation.
4. Delivery to employee at premises
❑ At A.MJP.M. on at
I attempted to personally serve the herein Notice
of Violation on the respondent named herein but
was unable to do so 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
(name) that the respondent
was not then present;
❑ unable to secure identification of the person(s)
present;
❑ advised by
(name) that no officer, director,
managing agent or general agent of the respondent was
present;
❑ service could not be made because
Thereupon, I delivered a copy of the herein Notice of Violation
to
whom I believe to be an employee of respondent at the
premises because:
❑ Employee so identified ❑ Employee was performing ❑ Other
himself/herself work consistent with being
employed by the
respondent
Description of individual this must be completed for all
types of service except corporation)
Deponent describes the Individual served as follows:
0 male ❑ white skin ® black hair
❑ female ❑ 14-20 yrs. ❑ Under 5'
❑ black skin ❑ brown hair Q 21-35
19 yellow skin ❑ 5'0-5'3"
0 blond hair ❑ 36-50 ❑ 5'3"-5'9"
❑ brown skin ❑ gray hair ❑ 51-65
❑ red skin 5'9"2'0"
❑ white hair ❑ Over 65 Cl Over 6'
Cl under 100 lbs. ❑ 101-130 IR 131-160 0 161-200 ❑ over 200
Other identifying characteristics:
5. Service by Mail
❑ by 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 BEFORE ME ON THE yff
Signature
DAY OF 19
Printed Name
Aot 9
I Badge Number orTiae
NYC-WTC 000102066
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