NYC-WTC_000166105

NYC 9/11 Public Portal Document

]!G. , i _ .; _ .. .. AFFlMITY OP f~1~k7! Y ' ' V.. --~ State of New'rbrk of N~ tU Y o R K , ~: The undersigned being duly sworn' deposes and says: That deponent is not a party to the action and 1s over 11)yeah of age; That, o n. `''~ ( . 3 . - 18~ at ___~_ AM/PM at 7 Wu ~c L n Tte fr n e- c EnV T"E 2 N Y 00 ts depen.M aan.d th..rnhln Holica can and Hearing on the responders named herein. .

I. Individual; Personal Service - L—J .S ❑ by delivering a Vus copy to said respondent personally. ,. .. _ . %_r,

It. lndWfdual; Substltubd 8arvk:e . _ .l ..

❑ by delivering a true copy to ' .: .a persond raeEabe age and discretion. Said premhss Is respondent's i ecard place Of twarneaa dae0brg muse or usual place of abode wfrlrar tAs sans.--- : ~• '----J .i Ill. Corporation _.~..•r ❑ by delivering a true copy to_- :_._,-: .. ' said corporatIon.

.1. ..,. .. . • . .: , .. ,., v.L rJ .1-,': - ! .- ,'a:r ,. In Lo. , v, . ..~ . .....;Ji. . . ,. . . . _ ... , . , _ . .: r I-s IV. Del Employee at Premises t . .

by delivering a true copy to respondent's employee at the above location: (answer A and B) . - ` .. A. I attempted to personally serve the herein Notice of on the respondent named herein but was unable be do so because, having entered Onp" ItavIngisntIfted .- _ . .. ..... ......r , . . myseen, I was: 1. ❑ advised by that the respondent was not then present and premises Is neither respordae's acted placed buskew nordwOn1ghouse

2. ❑ unable to secure klentlnrarlon d t e persona) present; .._ .... . .. .f~dle •~,.

a ❑ advised by that no officer, director, managing agent crpent of respondent corporation was prosaic... ..

a d Thereupon, I delivered a coq the herein Noticed Violation to !S N ~L J q f1' T. wham I behave to be an employee of respondent at the premises because; (check 1, 2 or 3) - - -- .. -... .:. .. 1. Employee so iderdifi hl _ . . .

2. ❑ Employee was performing work consistent with being employed by the respondent; or .. . ._ . - _. .._. a ❑ Other: ..

_ . - Description of Individual. (This must be completed fa all types d service except corporate, Number III, above.)...'.':. ;•, ". '.' ..; Deponent describes the Individual served as tollo": , _...: , . .... „m,54 •. _, .

--__ O Under 100 ste t'Mlale hite Skin O Black Hair - O14-20 • - - - .O Under 5' :.. .. .. O Female O Black Skin U Brgwn Hair • O21 5 .. O S'0'r5'3" ..'._ ._ri:,,, "D 100.130' . . blond Hair '.t '--~ ' ',,, ~: ; : O 8'4'x'8' ... . O 131460' ❑ lbllow Skin ... .,~..❑ ❑ Brown Skin 0 prey Hair.. 61.86_-.. - ,] ~ O 5'9"5'0' O161300 ❑ Red Skin O Red Hall ' "- - ' O Over 66 'O'er e' '" ' . t3'Ovar 200' O White Hair ' - - '- .. .,,.. .. .. , O Bakerlg : .. _...... ._m...,......,._ .._L _ ,

Other kiemllying duractadstics: .

" t,..; •.. .-,°. ._ .. ro _:" ...... .. f 19 „ .. J,:1 '.. Swan m before me on

' If not sworn, this statement shall constitute a certificate of serce. .... .., . _ . .. .. I.

. _. .__ •_•.' . • c. -:Sit ' , ..

.. ... .0 1.,,... ... .sac r.l';,p :,u:. .. ,. . . . , f_... . ._.. - .. .. - l ` . . _se .... . , .. . . .,. . _ . . •. .. ..

NYC-WTC 000166297