Affidavit of service form, New York City, 2002

NYC 9/11 Public Portal Document

AFFIDA\'IT OF SERVICE ST \11 QTR \1 \' Y`')1'K ('Cll1,y_LY OF

nc, tuidcrsi~ncd l ; ,: dole swotu. dehc 19 at A.M_tl'.M The deponent is not a party to the action and is over I S years of age. that can 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 ❑ by delivering a true copy to , a person of suitable age and discretion. Said house or usual place of abode within the state. premises is respondent's actual place of business-dwelling 3. Corporation -❑ -- by delivering a true copy to (name) said corporation. .. fr (position) a't

4.Delivery to employee of premises — _-at _- i attempted to personallysera the ❑ At A.M./F:M on because: herein order on the respondent na red herein but was unable to do so ❑ }raving attempted entry to the premise$* I foundtkie premises, locked and no oar responded_ to any bells, (Mocks,,. or calls. 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 wham 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 performing work consistent 0 Other ❑ Employee so identified himself/herself with being employed by respondent

except corporation) Deponent describes the individual Description of individual - (this must he completed for all types of service served as follows: 0 black hair 0 14-20 years 0 under 5'0" 0 under 100 lbs. ❑ mate 0 white skirt 0 brown hair ❑ 21 -25 ❑ 5'0" - 5'8" 0 101 - 130 0 female 0 black skin 6'0" 0 131 - 160 0 yellow skin 0 blond hair 0 26 - 35 0 5`9" - 0 gray hair 0 36- 50 0 over 6'0" ❑ 161 - 200 0 brown skin 0 white hair 0 51 -65 0 over 200 ❑ red skin ❑ balding ❑ over 65

Other identifying characteristics:

5. Serve ice by Mail be deposited the same, in a post paid wrapper, in a post:' ❑ by mailing a true copy to respondent by depositing or causing to office station regulatly maintained by the U. S. Postal Service.

SWORN TO BEFORE ML ON THE Signature DAY OF , 19 Printed Name tack of Environunental Control Board - White

NYC-WTC 000118499