Affidavit of Service form, Vesey Street, 2002

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE STATE OF NEW YORK, COUNTY OF — —___-- - -- -

l lie undci signed being duly swot u. depose., and says , l9 at — A M /PM The deponent is not a party to the action and is over 13 years of age. that on deponent served the within order on the respondent named therein. at 1. Individual; personal service ❑ by delivering a true copy to said respondent personally 2. Individual; substituted service ❑ •bv-delivering a true copy to - , a person of suitable age and discretion. Said abode within the state. premises is respondent's actual place of business-dwelling house or usual place of 3. C irp iration , (position) at ❑ -- by delivering a true copy to (name) said corporation. 4. Dclivciy10 employee at premises

A.M./P-M on .. ... ... ----at - I attempted to personally serve the- - ❑ - - At. herein order on the respondent .najned herein but was unable to do so because: _ :• responded- to any belts, knocks..„ „❑ - having,attem_ pted entry to ti pcntise, I found the premises locked and no.fl or calls. 0 having entered the premises and 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 , whom I believe to be an Thereupon, I delivered a copy of the herein order to employee of respondent at the premises because: 0 Employee was perforating work consistent 0 Other 0 Employee so identified himself/herself with being employed by respondent

Deponent describes the individual Description of individual - (this must be completed for all types of service except corporation) served as follows:

0 0 black hair 0 14 - 20 years 0 under 5'0" 0 under 100 lbs. ❑ mate white skin 0 ❑brown hair 0 21-25 0 5'0"-5'S" 0 101-130 ❑ female black skin ❑ blond hair 0 26-35 0 5'9" - 6'0" 0 131 - 160 ❑ yellow skin ❑ brown skin ❑ gray hair 0 36 - 50 0 over 6'0" ❑ 161 -200

❑ white hair 0 51 - 65 0 over 200 ❑ red skin ❑ balding ❑ over 65

Other identifying characteristics:

S. Service by, Mail •• same, in a post paid wrapper, in a post' 0 by mailing a true copy to respondent by depositing or causing to be deposited the office station regulatly maintained by the U. S. Postal Service. SWORN TO BEFORE ME ON THE Signature DAY OF , 19 Printed Name' Back of Environunentat Control Board - White

NYC-WTC 000111943