Affidavit of Service form, 1 Park Row, undated

NYC 9/11 Public Portal Document

` 4 AFFIDAVIT OF SERVICE

STATE OF NEW YORK, COUNTY OF ICI- FW The undersigned being duly swrsns, deposes and says: The is a party to the aionm4 8 years of age. That S^ Z ®2 at1"A t~at deponent within ORDER on the respondent named therein. 1. Individual personal service ❑ by delivering a true copy to said respondent personally 2. Individual substitued service ~—A , / t~ Xcy delivering a true copy to G Fib / )t~r)7 ML /~f /CE' 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. (Position) 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; ❑ advised by that no officer, director, m' g (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: ❑Employee so identified ❑Fmployee was performing work ❑Other himself/herself 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 as follows: male white skin ❑Black hair 014-20 yrs ❑ Under 5' 0 Under 100 lbs ❑ female ❑ black skin gown hair 021-35 ❑ 5'0"-5'3" 0101-130 ❑ yellow skin 0 Blond hair ' 036-50 0 5'4"-5'8" ❑ j,31 - 160 ❑ brown skin ❑ Red hair X51 - 65 '9" -6"0" 161 - 200 ❑ red skin 0 Gray hair ❑ Over 65 ❑ Over 6' 0 Over 200 ❑ White hair ❑ Balding Other identifying characteristic-

5. Service by Mail OBy 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 TURF p ~ DAY OF 19_ , tea / ~ /E1 PRINT NAME

DERTA — White LEGAL — Pink

NYC-WTC 000115768