Affidavit of service form for legal order delivery

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE

STATE OF NEW YORK,COUNTY OF N.W' K The undersigned being duly swaans, deposes and says '

r

1. Individual personal service ❑ by delivering a true copy to said respondent personally 2. dual substitued service G delivering a true copy to C 1 a person of suitable age and discretion. Said premises is respondent's actual place of businessd yelling horse or usual place of abode within the state. 3. Corporation ❑ by delivering a true copy to at said oaporation. (Position) 4. Delivery to employee at premises ❑At .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; 0 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; ❑ advised by that no officer, director, managing ( ) 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 of respondeent at the premises because: ❑Employee so identified ❑Fmployee was performing work ❑Other himself herself consistent with being employed by the respondent

Description of individual - (this must be completed for all types of service except corporation) Deponent describes the individual as follows: male ❑ white skin .lack lair 014-20 yrs ❑ Under 5' ❑ Under 100 lbs 0 female • black skin OBrown hair 1- 35 0 5'0"-5'3" ❑ 101-130 ❑ yellow skin ❑ Blond hair 036-50 ❑ 5'4"-5'8" ❑ 131-160 ❑ brown skin 0 Red hair 051-65 -6"0" X61- 200 ❑ red skin 0 Gray hair ❑ Over 65 ❑ Over 6' 0 Over 200 ❑ White hair ❑ 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, bra post office station regularly maintained by the U.S. Postal Service.

SWORN TO BEFORE ME ON TBE DAY OF 19_

DERTA — White LEGAL —I Pink

NYC-WTC 000130780