Affidavit of service form for legal order delivery

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE

STATE OF NEW YORK, COUNTY OF ~' "~;V ~ The undersigned being duly swoms, deposes and says: , The dyponent is a party tot$e on andis ~~ ofage. Tit an ti J

1. Individual personal service ❑ by delivering a true copy to said respondent personally 2. Individual substitued service )aty delivering a true aapy 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 ❑ by delivering a true copy to at said coporation. (Position) 4. Delivery to employee at premises ❑At AM/P.M on at I attempted to personally serve the herein ORDER on the respondent named herein but was unable to do because: 0 having attempted entry to the premises. I found the premises locked and no one responded to any bells, knocks, or calls; ❑ 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 persons) present; ❑ advised by that no officer, director, managing (Name) 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 ❑Employee was performing work ❑Other himself/herself consistent with being employed by the respoident

Description of individual - (this must be completed for all types of service except corporation) n .+ Deponent describes the individual as follows: t1male ❑ white skin Slack hair 014-20 yrs ❑ Under 5' ❑ Under 100 lbs 0 female 0b1ack skin ❑Brown hair 21 -35 0 5'0"-5'3" ❑ 101-130 0 yellow skin ❑ Blond hair 036-50 ❑ 5'4"-5'8" 0131-160 ❑ brown skin ❑ Red hair 051-65 , 5'9" -6"0" _f 161-200 ❑ red skin 0 Gray hair ❑ Over 65 ❑ Over G OOver 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, in a post office station regularly maintained by the U.S. Postal Service.

SWORN TO BEFORE ME ON THE L ~ DAY OF 19 La PRINT NAME

DERTA — White RESPONDENT — Yellow LEGAL — Pink

NYC-WTC 000130781