NYC-WTC_000166105

NYC 9/11 Public Portal Document

_ AFFIDAVIT (CERTIFICATE') OF SERVICE

State of New York, County of ) ss

The undersigned Doing duty sworn' deposes and says: That deponent is not a party to the action and is Over IS years of age; That on'_ _ 19_ — at __rte . - AMlPP am at deponent served the within Notice of Violation an. Hearing on the respondent named herein. -'^

.1. Individual: Personal Service t, ` „ ,f4 l ❑ by delivering a true copy to said respondent per!orWty.1 .. ! ? ,i l• ... _. . .

II. Individual: Substituted Service ..-_... . .omc.

by delivering a true copy to -1 - ; a per t Of suhable age and discretion, Said promises is respondent', actual piece d business, dwelling 9 house or usual piece d abode wine, ime SYlla._i....: : •- _ t ) ... _ o . .._.. . _ .. ~_ ..;.•_7.. .. _ _. III. Corporation . ❑ by delivering a true copy to :U 'U U , rr wua ...• ^' at said corporation •

IV. Delivery to Employee at Premises . ... ...-

by delivering a true copy to responoem's employee at the above location! (answer A and 8) A. I attempted to personally serve into herein Notice of Violation on the respondent named herein but was unable to 00 50 bemuse, having entered the ptemisea and having ttlendfisr myselt, I was: - - -- .

1. advised by that the respon)Oent was not then present, and premises is neither respondem's actual place of busirie9s rldr tlwelfing ...house

2.D unable to secure identification of the person(s) present: - • UU a.,. U

_ 3. ❑ advised by no officer, Director. mane9in9 ge agent oregem of respondent corpbration- yrse ~ ....r present? B. Thereupon, I delivered a copy of the nee fblice of Violation to _ wv whom believe 10 be rht *lt?rployee of res dem at the premises because; (check 1. 2 or 3) U - 1. O Employee so identified hindhersafl;

2. I__I Employee was performing work consistent with being employed by me respondent; or

3. L Other:

Description of individual. (This must be completed for all types of service a cept corporate, Number Ill, above.) U . - •? y f Deponent describes me individual served as totiows;

;.~ Male i t White Skin [! Black Hair ilI 1420 - r'1 Under 5' ' ❑ Under 100 Ik iT Female O Black Skin ^ Brown Hair n 21-35 .._ O 5,0•t5.3, _. ...._..Ll t00•?30 C. Yellow Skin - i-) Blond Hair ❑ 36-50 05'45'8 r'e.,nO 131.160 • • .i' Brown Skin rl Gray Hair P. 51.65 •- fT 5'96'0' "❑ f61.200J, Ti Red Skin O Rea Hair Ct. Over 65 C) Over 5' "".. 6"Over 200 it While Hair 'e. Balding . .. . . re' .. ., . - ,^

Other i0 nrying cnaratxensucs: _ _ _____ _ __ _ _ ___ _ ii

ruu Ntselhc MIMf .. Sworn to before me on 18_, — ..,

' It clot snv)rn, ims statement shall constitute a certificate of service. .

NYC-WTC 000166223