Affidavit of service for legal order, undated

NYC 9/11 Public Portal Document

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AFFIDAVIT OF SERVICE STATE OF NEW YORK, COUNTY•OF

The undersigned being duly sworn. deposes and says. , 19 at A.M./P.M. The deponent is not a party to the action and is over 1 S years of age, that an deponent served the within order on the respondent named therein. at I lndlvtdtral; personal service ❑ by delivering a true copy to said respondent personally. 2. lndii-idual; substituted service ' . CI bby-delivering a true copy to - , 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, Corporiiion (position) ai *❑ by delivering •a true copy to (name) said corporation. _.... 4. Dc ery iii employee of preiii1s - • .0. .- M- _ _ -. A.M./FM on -at —_• ---.I attempted to personaflyserve the-'- h . ard" on the capon dhereinbut was unable to do so because: ,~; ;: .• ❑..:...... : : ,.t'ur8 I_ ound _ the.P ses liked and F9fie respded to any bells,. '. ~, ... ' ted try tp dr f 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 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

corporation) Deponent describes the individual Description of Individual - (this must be completed for all types of service except served as follows: ❑ white skin • © black hair 0 14-20 years ❑ under 5'4" ❑ under. 100 lbs. ❑ male . ❑ brown hair ❑ 21-25 0 ,50" -5'S" ❑ 101 -130 ❑ female ❑ black skin ❑ yellow skin ❑ blond hair ❑ 26-35 0 5'9" - 6'0" ❑ 131 -160 ❑ brown skin ❑ gray hair 0 36-50 0 over 6'0" ❑ 161-200 0 white hair 0 51-65 ❑ over 200. . ❑ redskin O balding 13 over 6s

Other identifying.characteristics:

.. S Serylce by.1M1(all . . deposited the same, in a post paid wrapper, in a post' ❑ by mailing a true copy to respondent by depositing or causing to be office station regulatly maintained by the U. S. Postal Service. ..SWORN TO BEFORE ME ON THE Signature . ... , 19~ .. - _. . .._ .... . . . _ DAY OF .. Printed Name : •

Flack of Eoviroranetdat Coattol Board -White

NYC-WTC 000119691