Affidavit of Service form, DEP asbestos enforcement action

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE STATE 01, NEW ' YORK COl !NTY OF

I Ii c iindcrsi ued lienu duly s~v t r t. del~o.es ai-d Ncly I_ , 19 A.M./P.M The deponent is not a party to the action and is o\er 18 year, of age, that on at

at deponent served the within order on the respondent named therein. 1. Individual; personal service ❑ by delivering a true copy to said respondent personally. 2. Individual; substituted service ❑ ),ndeliveri»g 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. Corporation , (position) at ❑ -- by delivering a true copy to (name) said corporation. 4: Delivery io emp1okcc at premises --at _ _ ._. _ --. .. -1 attempted to personallyserve the- - ❑ At -A.M./P M on herein order on the respondent 9na rted herein but was unable to do so because: to any bells, knocks,,. • ►aging attempted entry to the pjenuses. I found tkte premises.1ociced adnopnc,responded. 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 so identified 0 Employee was performing work consistent ❑ Other himself/herself with being employed by respondent

except corporation) Deponent describes the individual Description of individual - (this must be completed for all types of service served as follows: 0 black hair ❑ 14 - 20 years 0 under 50" ❑ under 100 lbs. ❑ male ❑ white skin ❑brown hair ❑ 21 -25 0 5'0" - 5'8" 0 101 - 130 ❑ female 0 black skin ❑ yellow skin 0 blond hair ❑ 26 - 35 ❑ 5'9" - 6'0" 0 131 - 160

❑ brown skin 0 t'a~ay : hair 0 36 - 50 ❑ over 6'0" 0 161 - 200 ❑ 51 - 65 ❑ over 200 ❑ red skin ❑ white hair ❑ balding ❑ over 65

. Other identifying characteristics:

5.. Service 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 ME ON THE Signature _ .._ _DAY OF , 19` Printed Name Back of Environmental Control Board - White

NYC-WTC 000119240