Affidavit of service form for legal order delivery

NYC 9/11 Public Portal Document

AFFIDAVIT OF SERVICE

STATE OF NEW YORK, COUNTY OF F, ,r' `, t The undersigned being duly swmns, deposes and says: -, The deponent is note party to the gtion and is over 18 years of age_ That on lJ . at G , AM /P.M at deponent served-the within ORDER on the respondent named therein. 1. Individual personal service ❑ by delivering a true copy to said respondent personally 2. Individual substitued service i . Y de 'by a true copY to ~- a - v ;- a person of suitable age and discretion. Said premises is respondent's actual place of businessd elling 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 A.MJP.M on at I attempted to personally serve the herein ORDER on the respondent named herein but was unable to do ❑ 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 pres (Name) ❑ unable to secure identification of the person(s) present; ❑ advised by that no officer, director, managing (Nsme) 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: 0Employee so identified ❑Employee was performing walk ❑Other himselflherself 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: 13 male ❑ white skin A Black hair 014-20 yrs 0 Under 5' ❑ Under 100 lbs ❑ female ] black skin ❑Brown hair 1121- 35 ❑ 5'0"-5'3" ❑ 101-130 ❑ yellow skin ❑ Blond hair 036-50 ❑ 5'4"-S'8" ❑ 131-160 ❑ brown skin ❑ Red hair 051-65 ES9" -6"0" 161- 200 ❑ red skin ❑ Gray hair ❑ Over 65 ❑ Over 6' ❑ Over 200 _R ❑ White hair ❑ Balding Other identifying 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 ~ stGNA f 19_ c ,fir -/ DAY OF PRINT NAME:

DERTA - White LEGAL Pink

NYC-WTC 000130782