NYC-WTC_000166105

NYC 9/11 Public Portal Document

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_ _ _ . _. _. . ... AF'FIDAVIT (CEMW GATE-) OF SERVICE - .~.._I _•L' ` / '.+ Stale o1 New tbrk. County of Q•t•^~ 1~2 1Z } as: .. • } ..

The undersigned being duty ewom'.deposee and aaya: That deponent b not a parti.to the action and is over 18 years of age: That on ~L.-. ~ 19 . at _____ AM/PM . al / L/)o'tt i- ► ) R ff !J'2- ( PM iR deponent served the within Notice of Violation and

/Ieaflng on the respondent named herein. .• - ._ _ L Individual; Porsonat Sorvlost_n. ,.F -.ii' .. _ „I .u_.. • Li. ,.L t - . L.LJ .ii. - I ❑ delivering a live copy to said respondent personalty. l... j _ ' by •G_ ... . . I

. . .., , .e ern" t.,•,I u individual: Subst(Iupd Service I 1 i 1 l .L. i_ -i__ ❑ M delhhrint~rlw copy ro !- ~ --- a person of auileble age and dlecratlon. Said premises Is respondents

Baud plecg` business, EoeNrip house fir usual place of abode within the. Stets t !

Ill. Corporation . . -. . 4 at said corporation. Q by delivering a true copy to_'_.'_ , sot )•n.i ,.. ;luwgn, ,. : : . . .. .. _ ,' ,vl,.... _. , , ... _ .,nq :Is'b,._ N. Detvery to Employee at Premises .. , . .' '~ by delivering a true copy to respondent's employee at the above location: (answer A and 8) h~A I attempted to personally serve the herein Notice Ot.tdiOlatlOn on the respondent named herein but was unable to do so because,having entered the promises and having Identified .. .. _ w. myself. I was. . . qtr:. •-

1. ❑ advised by that the respondent was not then present, and premises to neither respondent's scud place d business nor dwelling house.

911: 2. ❑ unable to secure Identification cf the person(s) present..: _ _, ,. .. ,,: .:.tra,,. ;b .

a ® advised by M A R/_._' ) . _/ that no omcer, director, managing 09001 or agent of jeepoildent corporation was present.

R.--- Thereupon, I delivered a copy of the herein Notice of Violation do -') A R-hC N 'Viii f 11 !- (/rl•/u1' •~F, ie whom I believe to be an employee d respondent at the premises because: (check 1, 2 or 3) —~ 1. Employee so Identified himtherselh, - -

2. ❑ Employee was performing work consistent with being employed by the-respondent: or - __

a ❑ Other: ..:

Description of Individual. (This must be completed for all types of service except corporate, Number ill. above.) '" _ — Deponent describes the individual served as follows: '- : b143oh :.

.,,. ..O ' ~ ffilte Skin: ... . ••:... Black Hair L: ❑ 14-20 -' - .. . -- ❑ Under 5' - O Undo 100 Ibe la Mate - O Female O Black Skin 9 Brown Hal : ',II.R O21-35 O S'M6'3 - ❑ 100-130 _. ,:: A3 Yellow Skin .. . .... . .'-O Bland Hair a 3&50 "' 3'#'t5'a' $131-180.. •.:1,:•: O Brown Skin - ._ O prey Hair ❑ 51-85 . ..: 0 5'9"8'0' _ Cl 181-200 R O 200• ❑ Rea Skin .., O Red Half' ❑ Over 65 ' o.O.er s' _. . L, • .e.,., . . - °O VAft Hair -1 O Balding :` IJA i :: fOianl, .. Other identifying chars--: :t) 0...r.nf:!. _ n 1:...' { . . I Jt ivarijy~yy .

l ~: _... / . A .,...,„:.Old L• boil c

em' ^. t::'...i t _::. •• _. :'IJ:ttl6'1,I P11 Sworn to before me an y -

S + wqawemwnc ems ... ... .. _. . 1,3:..•n c:. coat,..::_,.. . .,.._ if That sworn, this statemenfhat constitute a certificate of service.' .:t 1... • + .

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NYC-WTC 000166284