Notice of claim regarding premises liability, January 2012

NYC 9/11 Public Portal Document , U {\fi J 'MV’' Vf- •v-eiv Index No LL(L Petitioner(s) AFFIDAVIT Against OF SERVICE

J _____________________________________ Defendant(s) Respondent(s) county, new YORK STATE . being sworn, says: Deponent is rmt a party RercinTis over 18 yeara of age and resides at:

sag. ^4^375 Deponent served the within [ ] sununons [ ] with notice [] summons, Spanish summons and complaint, the language required by NYCRR [ ] summons and complaint 2900.2(e)., (f) & (h) was set forth on the face of the summons(es) (] notice of petition and petition [] citation , [ ] subpoena [ ] subpoena duces tecum ixKoP Sub pc’eiJQ [ ] defendant (hereinafter [ ] respondent called therein named 'itness the recipient)

PERSONAL by delivering a true copy of each to said recipient personally: deponent knew the person so served to be the person described as said recipient 1- [ ] therein.

CORPORATION a corporation, by delivering thereat a true copy of each to 2. [ ] Personally, deponent knew said corporation so served to be the corporation, described in same as said recipient and knew said individual to be Thereof. .^MTITUTED 3N^ by delivering thereat a true copy of each to a person of suitable age and discretion. Said premises is recipient’s ^^^Oactual place of business [ ] dwelling place [ ] usual place of abode within the state.

CONSPICUOUS by affixing a true copy of each to the door of said premises, which is recipient’s [ ] actual place of business [ Jdwelling place [ ] usual place of 4. [ ] abode within the state. Deponent was unable, with due diligence to find recipient ora person of suitable age and discretion, thereat, having called there

on at and on at and on at

Mailing to Deponent talked to at said premises who stated that recipient [ ] lived [ ] woiked there. residence Within 20 days of such delivery or affixing, deponent enclosed acopy of same in a postpaid envelope properly addressed to recipient at recipient’s ^.... last known residence, at ' and deposited said envelope in an official depository Under exclusive care and Custody of the U.S. Postal Service within New York State.

Mailing to - . . Within 20 days of such delivery or affixing, deponent enclosed a copy of same in a first class postpaid envelope properly addressed to recipient-at business recipient’s actual place of business, at use wjrt 3 or 4 in an official depository under the exclusive care and custody of the U.S. Postal Service within New York State. The envelope bore the legend “Personal and Confidential’’ and did not indicate on the outside thereof, by return address or otherwise, the the communication was from an attorney or concerned an action against the recipient.

DESCRIPTION SEX: ____ MALE JZ FEMALE SKIN COLOR: ^WHfTE, BLACK, YELLOW, BROWN. RED HAIR COLOR: ____ WHfTE, ____ BLACK, . BLONDE, j^BROWN, RED, GRAY, BALDING AGE: 14-20 _____ 21-35 36-50 51-65 OVER 65 HEIGHT: UNDER 5’ 5’0-53 ■5’4 - 5’8 - 5’9-6’0 OVER 6’0 WEIGHT: UNDER lOOLBS 100-130LBS . / I31-160LBS . 161-200LBS OVER200LBS OTHER IDENTIFYING FEATURES:

WITNESS $ the authorizing traveling expenses and one days’ witness fee: paid (tendered) to the recipient Q ] was mailed to the witness with subpoena copy.

MILITARY I asked the person spoken to whether recipient was in active militaiy service of the United States or of the State of New York in any capacity SERVICE Whatever and received a negative reply. Recipient wore ordinaiy civilian clothes and no militaiy uniform. The source oj "onnation [ ] the grounds of my belief are the conversations and observations above narrated. Upon information and belief I aver tht the recipient is not in militaiy service of New York State or of the UnitapS^pM Ml in either the State or in the Federal statutes.

SWORN TO BEFORE ME ON estd oma Notary PubTctete New York Bronx, JMew®¥wk NO. 01AB50f4371 Qualified in Westchester County^ Lie. # 932043 Commission Expires July 15, 201^

NYC-WTC_000159360