Affidavit of service form, 10 Cortlandt Street

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE STATE OF NEW YORK_ COUNTY OF

1h undersigned being duly sworn. deposes and say s- 19 at _ r1. ~1,%P.M. •nce deponent is not a party to the action and is over 1 S years of age. that on 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 bv-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, Corporation ; (position) ai r❑ -• by delivering a true copy to (name) said corporation. 4.Delivery lu employee at preiuiaes ---at -- I attempted to peraorrally serve the ❑ _ At - A.M./1tM on herein order on the respondent uained herein but was unable to do so because: any bells, IJ►ocks~, • ❑ rav ng, ttempted entry to thUp ises, I found Imo,promises, locke d and,noRKresponded. to or calls. 0 having entered the premises and identified myself, I was: ❑ advised by (name) that the respondent was not then present; 0 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;

0 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 ❑ Employee was performing work consistent ❑ Other himself/herself with being employed by respondent

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

Other identifying_characteyisties:

5. Service by. Mail same, in a post paid wrapper, in a post' 0 by mailing a true copy to respondent by depositing or causing to be deposited the office station regulatly maintained by the U. S. Postal Service. SWORN TO BEFORE ME ON THE Signature - DAY OF , 19 Printed Name Back of r rotunental Control Board - white

NYC-WTC 000126355