Affidavit of Service form, 1 Park Row, undated

NYC 9111 Public Portal Document

` i AFFIDAVIT OF SERVICE

STATE OF xsw YO RK, COUNTY OF M r IA/ \bn 1' The undersigned being duly sworn, deposes and says: The deponent is not a party to the aijtion ani3 is over 18 years of age. That on _ at /2' A1 L at F fr P!4. deponent serve the within ORDER on the respondeot",ry named therein. L 1. Individual personal service ❑ by delivering a true copy to said respondent personally 2. Individual substitued service f —R / ~by delivering a true Dopy toF_AaC _n.l7? tfAL — STd R E MAKA6-&~ 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 AM1P.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: ❑Employee so identified ❑Employee was performing work oOther 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: mate )t white skin ❑Black hair 014-20 yrs ❑ Under 5' • 0 Under 100 lbs 0 female 0 black skin ;9Brown hair ❑ 21 -35 0 5'0"-5'3" ❑ 101 -130 ❑ yellow skin ❑ Blond hair 036-50 ❑ 5'4"-S8" 0131-160 ❑ brown skin 0 Red hair 51 - 65 (5'9" .6"0" ,,1161 -200 ❑ red skin 0 Gray hair D Over 65 ❑ Over 6' ❑ Over 200 ❑ White hair ❑ Balding Other identifying characteristic:

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 TEE " SIG ATURE DAY OF 19_ PRINT NAME

DERTA — White RESPONDENT — Yellow LEGAL - Pink

NYC-WTC 000115769