NYC-WTC_000166105

NYC 9/11 Public Portal Document | A GBSSTOOE ciel he cs nee re bane z i ‘AFFIDAVIT (CERTIFICATE*) OF SERVICE : STATE OF NEWYORK ) ‘ dss: COUNTY oF. ) : ; ‘The uidersined being duly sword” depoies nd say, that ne snot» pay othe action and is cover eighteen (18) yeas of age, that on (1 at pana, at fades} pet er SE OE De TN TP EARLE) ‘served the attached Notice of Violation and Hearing onthe Respondent named herein, as follows: ! 1. Individual Respondent | : toby delivering a ue copy to [insert name) ye i «whois the respondent = " 2. Partnership Respondent i ; wo by delivering a tie copy to [insert name!) m cs : ios the finset position] “af said eapondent. © 3.) Corporate Respondent ome } ‘by delivering a tue copy to [insert name:] aaa a ‘who isthe [insert position:] of said respondent. 4... Alfixing of Notice of Violation and Hearing ate ‘ i ‘A... Lattempted to personally'sérve the attached Notice of Violation and Hering on the s "respondent named herein but was unable to do so because, having entered the premises ang having” 4 «identified myself, ¥ was: : ‘ y Ay Dadvised by ingert names) ‘thatthe eespondent was nol present = | 2: tabbed op eee) SA : ‘ ‘ that a appropriate representative af the partesship respondent or corporate | respondent was not present; i 3. unable to seeure identification ofthe person(s) present; : Ce reat tate, 4... Cadvised by inser name) that ; ' _- officer, director, managing agen, agent, or parter of respondent partneeshplcomporation was present BL" Ttlereupod, Taffixed the Notice of Violation and Hearing at the foregoing location in i \ © the following place: : 2 : {The following isto be démpeted if person was served withthe Novice of Violation and Hearing} Descriptio of Individual: Depoient esetibes the individual served as follows: ‘i 5 Male White Skin Black Hair 014-20 yrs oUnderS*,..oUnder 100 fos” Females CBlack Skin’, ‘OBrown Hair, 21-38 yrs e8'0"-S'3" + 0100-130 bs Yo e¥ellow Skin “Blond Hair 36-80 yrs: S488" ASSO Ihe oon ren 8 Bree Skin EGR Hair” 51-68 yrs" 60" 161-200 Ibs” iDRed Skin “OWhite Hair... Over 65 yrs’ GOver6" Over 200 Ibs - Balding : ‘Other identifying characteristics: . fu Hecate hoes SUBIR set = ae a her Se eared 9 : Printed Name : Tak Registry Number: Swom to bore me on a nig ; ict Signature of Certifying Officer a . ke iets, os yy © Hf nat sworn, this statement shall constinte@ certificate of service. i NYC-WTC._000166110