NYC-WTC_000166105

NYC 9/11 Public Portal Document

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'~"'T"'ui4 sops Wrwpi►'.:~r._ .~ __.. '.., ' `...'-. . -c~~.,:~;`• _ ~~. ~ ..y.. '°-`'''~`-~'-~'r "t :. - ~rrc.~.''_r:.~-_ .~.. _ AFFIDAVIT (CERTIFICATE') OF SE/MCE 5 . . .. • 't rr j rr s1 New vnr. cm,nty n! i Z~ l.J ~ ¢ ,` ~ ss 1 •/ ~ p# • urn' Oepnses and says deo0nenl ,s not $page. taWsaG,pn and is r 16 yea`s of age, That on;:,. ~{~ 1 b~ y 111at !•~7 i ,_ AM;pM " I~ 1 q Y~ / l r f/r~ JJ _ _, f! 1 ~,: . _~ 1 ' ti . T.L 7 V~yy w. '1 deponent served the within Nni- rt volauor ane

-it the e aem named herein. i .r no,wduat: Personal Service

_j by delivering a true ropy to said respondent personally.

"d,idual; Substituted Service

J by delivering a true copy to .-. a person of suitable age and discretion. Said premises is respondent's

actual place of business, dwelling house or usual place of abode within the Stara.

.eiive•y ru hnrprpre at Prr intake

bt .; av u,py ,': rus,nn, erlt's 4mplovee at the above location (answer A and B) note,- ::nb n4irer. Notice of Viclabon or. tie respondent named herein but was unable to do so because. ttavllig e•'rlerei .he ppruritipes and ta:"1 ide:-i :•ed myself, I wae. . l advrsM h, .__ that the respondent was not then present. and premises is neither respondent's actual place of business no, dwelling house

enupi:: a. .xu•e :centiticai,o- c :ne aerson(s) present:

9 ? ~~.• y,r; ry _- tlpl no officer, director, managing agent or agent of r rtlent c poratmn was presen!.

Thereupon i r. •erEC a tops' ht tee reels Notice of Violation ~~~—;1 to -vwi n,m .\ _. _._ ::tc 1 bit: en':. is' i4 .I fl -.7•, •e rn :asnrnident at the premises because. (check 1, 2 vi 31

J•!nnbeo hrml:ai•sad.

2. O Employee was performing work consistent with being employed by the respondent. or - '•

1 fi . -- - -- '- ---_._.-' ----- --`------- - -- -- - - - ---

:r!ption of Individual. (This must be completed for all types 'rvice except corporate. Number III, above.) c r., i s rrres mv. Inu•wdual served as ihllo'wS. _..

.. _ `•'1Y':•ic Si r' Black Hair : . 14.20 1 • Under 5 . . Under 100 lbs _. Cileca Stir Brown Hair r-' 21-35 • , 5'0-5'3" 100-130 —, • _ . _ .. ( !end Hair : 3§.50 5'4"h' ' . 131.1660 5•ovn So'r . Fray Hair '\51.65 : 5.9{'0" ,•2`'61-200 ' Rer Ped Hai: / — one: 65' >ver 6' over 200 "-k-- r. . Write Hair Bathing -

,,•'- ' t iii 1

;r1

mis staterneni snail consinute a cariilicate of service.

NYC-WTC 000166166