NYC-WTC_000166105

NYC 9/11 Public Portal Document

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AFFIDAVIT (CER11F1CATE') OF SERVICE -,,., ~ - -~"r•~ f. -. _ - ~- - _ - -- State of New `lurk. County of - ~......-•.. } as: H.~ . -. • . .-~-

The undersigned being duty sworn' deposes and says: That deponent is nota partyto the ac ion and is over 18 years of ; That on- ; - - - 19_ at__ r - ~AMfP! at _ _ . - ---.'-- ° 'R _ --- - • eponent served the within Notice of Violation ark Hearing on the respondent named herein. , - - %' . - i - ; Individual: Personal Service ,r z• L t too^ , — ❑ by delivering a true copy to said iespondam ~pergonti9 . } •#_ t t • # ;--- ~- { - .. ~'. -t '. _ — T •. _._ i, _ If, Individual: Substituted service ..3•C[: •r_, -- . } by delivering a true copy to --' i.' :a>- _ ❑ . -._.. - - , . '. • .,"— - - ... --'..'' -- . ' a pa d su}feaeage artd'discretion.- Seld premises is respontierd's actual place of business. dwelling house pruuei }pkto-d abode will , the-Sfere-r-1 _ _L. . 1 rs- 01

. ,..._. .,..: 111. Corporation a4tr ? -S ,brO t.L -❑ by detivenngta true copy to'! r. i::r,-- a', _ - ..ar.- - - - w> r _ - ei said ~6rporetlon. - IV. Delhvery-to Employee at Premises- . .. _ .. - - - _ —. - _ _ . . ,~ F r ❑ by delivering a true copy to respondent's employee at the above location: (answer A and B) A. 1 attempted to personally serve the herein Notice of Violation on the respondent named herein but was unable lode so because. having n94ntered tine premises end ,having identified -. -- - - myself, I was:_ f ,. _ - _

1 • that the respondent was not httirr present and premises is neither respond'ent's actual place o( busu rror mg ise 2.0 unable to secure identification of the persons) present •;:.: ~> :,,.: _ - ! ~.;, ______ _g• ' y_

a ❑ advised by :f ' , .- - - Mat no officer, director, managing agent or agent of respondent iidrporairon Mes prase +' B. Thereupon, I delivered a copy of the herein Notice of Violation to .-.,,,p - whom I believe to bean employee of respondent at the premises because: (check 1, 2-or 3) - - -_ _ : .x• a ?. • 1. • ❑ Employee so identified him/herself: . .-.

2. ❑ Employee was performing work consistent with being employed by the respondent; or r • ,,, — -. — _ a [I Other:

Description of Individual. (This must be completed for all types of service except corporate, Number III. above.) .- _ - r^* :~iF:.t- : : .. r.es. --ai - - f"- Deponent describes the individual served as follows; - r ---- - •-' - _ _.

❑ Mate ❑ White Skin ❑ Black Hair _ -- ❑ 1420 '1 •r'i''Under5 ' - • Q3lnder 00 roe C Female O Black Skin ❑ Brown Lair - ❑ 21-35 . . .. ......---O5'r.5'3-- - "---'-".-'--9J100-130 O Yellow Skin -- Ll Bland Hair ' ❑38.50 O545'8" Oi o npa'31:(8g1. •• C Brown Skin ` O Gray Hair -'---O 51-&5 - • -^- ` 59 8'0" 1 . .. O Red Skin O Red Hair_ ❑ Over 65 O6er8'_ O White Hair .tr • rtt>;' . —Qf3atding — Y._....

Other identifying characteristics: t :L- -2!E-_6t -Jk ddR. a slur -

.,'s .' 2F• r , .i .Sirs ~J Sworn to before me on - 19_. `•i.r .? ,r rat' Spin -r.0 tb aJn3sw`n5td eisC __ _ _ -

s,r✓.cu.~o.amsw~an~n — "• - -'•t:.c`: 1 •vE•k

If not sworn, this statement shall constitute a- certificate-of service. __ ;r r• i;r ' _ —___ ---

i c3;ter-. -

NYC-WTC 000166209