Affidavit of service form, 52 Beekman Street area, 2002

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE

STATE OF NEW YORK, COUNTY OF := f `, `. The undersigned being duly svwtns, deposes and says: ;-- The deponent is not a party to the action and is over 18 years of age. That of at : . AM/P.M.at ' . orient served the within ORDER cm the respondent named therein. 1. Individual personal service ❑ by delivering a true copy to said respondent personally 2. Individual substitued service Pby delivering a true copy to } e.~° .I ' ca! 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 A.MJP.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 ofrespcadxnt at the premises because: ❑Employee so identified ❑Employee was performing work DOther himself/herself consistent with being employed bytherespcssient

Description of individual - (this must be completed for all types of service except corporation) Deponent describes the individual as follows: C male Xwhite skin ❑Black lair 014-20 yrs ❑ Under 5' ❑ Under 100 lbs ❑ female 0 black skin ,gown hair 21 - 35 0 5'0"-5'3" 0101-130 ❑ yellow skin 0 Blond hair b 36-50 ❑ 54"-5'8' ❑ 131 -160 ❑ brown skin 0 Red hair 051-65 , 59' -6"0" 161- 200 ❑ red skin 0 Gray hair 0 Over 65 0 Over 6 ❑ Over 200 0 White hair 0 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 THE SIGNATURE DAY OF 19__ PRINT NAME

DERTA — White LEGAL — Pink

NYC-WTC 000118867