NYC-WTC_000166105

NYC 9/11 Public Portal Document

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AFFIDAVIT (CERTIFICATE') OF SERVICE

Slate of New York, County of ) so: .

The undersigned being duly sworn• deposes ace says: That deponent is not a party to the action and is over layouts of ago: That one- ._-~' L' 194at __ . AM/PM 1 at ~~ deponent served the within Not.ce of Violation and Hearing on the respondent named herein. .

I. Individual; Personal Service by delivering a true copy to said respondent personally.

it. Individual; Substituted Service by delivering a true copy to a person of suitable age and discretion. Said premises Is resom ieoxs

aduaf p/ace of business. Uwe/ling house or usual p/ace of abode within rho State.

Ill. Corporation by delivering a true copy to_.. _.. ._______________________________________ _ - __ _ at sold corporation.

'h De11 ry to Employee et Premises by delivering a true copy to respondent's employee at the above location: (answer A and 8) A. I attempted to personally serve the herein Notice of Violation en the respondent named herein but was unable to do so because, having entered the premises and having Identified myself was: .- -

1/ advised by _LIJ L L !~~ ~ ~^ _~'_ J _ that the respondent was not then present, and premises is neither respondent'sectual p see of business nor dwelling house.

2. ❑ unable to secure identification of the person(s) present; -

3. Q advised by that no officer, dir ea(iaging agent or agent of respondent co rstioy was present. __ B. Thereupon, I delivered a copy of the herein Notice of Violation to who elieve to be an employee of respondent at the premises because: (Check 1, 2 or 3)~Fr I Employee so identified him/herself;

2. Q Employee was performing work consistent with being employed by the respondent; or

3. Other: ._ ~.-

jescriptton of Individual. (This roust be completed for all types of service except corporate, Number III, above.) Wopent describes the individual served as follows:

\ Male °StVliite Skin K, -. , lock Hair 14-20 fl Under 5 - '.7 Under 100 Ills .r Female 13 Black Skin C: Brown Hair [ " 21. L! 50-5'3 1! 100-130 is-: Yellow Skin LI Blond Hair 0-50 rl 5'4"'-5'B" ;"; 131-160 Fl Gray Hair f l 51.65 f 1 596'O V : 200 0 Brown Skin - El Red Skin iJ Red Hair H Over 65 Over 6' r 200 H White Hair T Balding

rther identifying characteristics:

Sworn to before me an l 1,4_ vo3 Fllo if not sworn, this statement shall cohstilute'e'curliticate'of setice.

NYC-WTC 000166175