Affidavit of service form, 19 Church Street, Oct 2001

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE

STATE OF NEW YORK, COUNTY OF ,. : y The undersigned being duly swans, deposes and says: The is not a party to the action and is over 8 years age. That ar .F '` c- at w j~Atitl:lP.M et 7 L fr u Y G Ft nt 1 i . . deponent served the within ORDER on the respondent named thaern. ~~- 1. Individual personal service Cl by delivering a true copy to said respondent personally 2. Individual substitued service by delivering a true copy to____________________________________________ a person of suitable age and discsetim Said premises is respondent' actual place of bus dwielling house or usual place of abode within the state. 3. Corporation . Eby a true to - ' e'e I.e 3 Of it i ,h S :tt 4 t a h S e w A a yr at said oapaatim (eoritioa) 4. Delivery toeipl e at prmnises tylG4t /PM an :? ! :; I attempted to personally serve the herein ORbER on the respondent named herein but was unable to do because: Cl having attempted entry to the premises, I farad the premises locked and no one responded to any bells, knocks, or calls;, 'l aving entered the premises and having ¢ed 110014 I was: 3'tldv1se1 by ti., , h Y r !' A! to f A a th at the respondent wasnotthen present j

O unable to secure id on of the persco(s) present; ❑ advised by that no officer, director, managing ame) agent or general agent of present; O service could not be made because

Thateupon, I delivered a copy of the herein ORDER to whom I believe to be an employee of respondeent at the premises because: so identified $, mployee was performing wk DOther himselfl'hawrilt^ consistent with being employed by the r+espandeat

Description of individual - (this must be completed for all types of service except corporation) Depcment desca'bes the individual as follows: '6Er hale QAhite skin OBiack hair 014-20 yrs 0 Under 9 0 Under 100 lbs O -female 0 black skin COrown hair 021-35 0 90"-53" 0101-130 Cl yellow skin 0 Blond hair 036-50 ❑ 94"-5'8" 0131-160 0 brown skin 0 Red hair t$1-65 l 6'9" -6"0" I,"R161 - 200 0 red skin C,' rray hair 0 Over 65 0 Over 6' Ct Over 200 ❑ White hair 0 Balding Other identifying chatacteristic:

5. Service by Mail C®y 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 ft /i _€4ø% DAY OF 19_ PRINT NAME

DERTA - White RESPONDENT — Yellow LEGAL - Pink

NYC-WTC 000126950