NYC-WTC_000166105

NYC 9/11 Public Portal Document

AFFIDAVIT (CERTIFICATE-) OF SERVICE

Slate of New York, County of ) ss:

The undersigned being duty sworn deposes and says: That deponent is not a party to the action and is over f h years ofage; That on 19_ at _ AM/PI- dl i deponent served the within Notice of Violation anc a Hearing on the respondent named herein. - - ---"

I. Individual: Personal Service 1. - 4 1

❑ by delivering a true copy to said respondent perfpyly.1„

It. Individual; Substituted Service -"•- - •' ❑ by delivering a true coq to - ._ -- a person at suitable age and discretion. Said premises is respondent's ~.c actual place of business, dwell ho e a usual prate of abode wifAin bw Shft-~ • -- - -- _

111. Corporation . _._ j._ _ _ ..__'.—:o-: •, .: .7 i.ti:r h:. _: by delivering a true copy to ... , r. <: ❑ at said rr

IV. Delivery to Employee a1 Premises

❑ by delivering a true copy to respondent's employee at the above location: (answer A and B) " i^ A. I attempted to personally serve the heroin Notice of Violation on the respondent named herein but was unable to do no because, having sniped the prefrtisisa and having identified myself. I was: - -

t. ❑ advised by that the respondent was not their present, and premises is neither sponge respondents actual pads d business nor draping fiouea. 2. ❑ unable to secure identification of the person(s) present; ll; -1hvr 3. ❑ ads sad by that no officer, director, managing agent or agent of respondent oorpolatton'was pnesei* B. Thereupon. I delivered a q of the nereitVotiee or Violation to .,_.; whom'1 believe to be in 1 tployee of respondent at the premises because: (check 1. 2 or 3) - t. ❑ Employee so identified him/herself; - - -

2. ❑ Employee was performing work consistent with being employed by the respondent; or

3. ❑ Other: V --

. . auto Description of individual. (This must De completed for all types of service uucep[ corporate, Number Ill, above.) f- ; •c/ Deponent describes Ina individual served as follows:

G Male f: Write Skin O Black Hair O 1420 -. fl Under 51 - •p Under 410.0 The C Female ❑ Black Skin ri Brown Hair r !0 21.35 Cl 5'0't5'3 —'❑ 100-130 Yellow Skin I Blond. Hair . ❑ 36-50 - ❑ 5.4'58' •• . _ • ' i b' "(1131-160 • ' Brown Skin ❑ Gray Hair , 1151-65 - ' t- 5'9"-6'0' ' __rVn 161-200'.. . —i Red Shin 1. ❑ Rea Hair (? Over 65 ❑ Aver 6' . • . `-`.. O Over 200 i7 White Hart ,O Balding -. . . . .. pr~+-

Otndr idemaying rnaraaensties: d k

toots to before me on 19_ . ,,,

--- - - _ _ .. - . . . scar..all ama,.c ua.

- If nor arvoln, this stalemenl shall constitute a Certificate Si service. r, •~

NYC-WTC 000166221