NYC-WTC_000166105

NYC 9/11 Public Portal Document

AFFIDAVIT (CER~IPICATE') of sER t .. .... _ ._...

Stltte^of NewYork'Coumy o} '7$t.se.¢`•o } . ..r ss- ..~~ ~ F ^. , , ¢

The undersigned being duly sworn deposes and says: That deponent is trot a parry to the action and is over 18 years of age: That on _ 19_ at AMIPI, - •• deponent served- the- within Notice of Violation ant Hearing on the respondent named, herein. - - - -

It. Individual: Persornl sarvice.~a 1 -::aPsY :rR:.".-s ''.].. 0"a t ,,.~ ,i~i_ -- - - ❑ by delivering abras copy to seW responnl de 1pereonss,j IL r ` .1.._'_

If. Individual: Substituted Service -•'~' - - - i.1 .' ' fee''.. t - dds l by delivering a true copy to -... — "8~persen o1 suitable age and discretion. Said premises is respondent's actualplace ofbusiness, dwelling~ house w usoI d abode within the St'sr ?a l a

r. Ill Corperstlon _.,. . . , . - I t' .. c 0, bq delivering aVue copy to - ' at said taPorafiort..

IV. Delivery to Employee at Premises - .. r. — - - :. 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 Violation on the respondent named herein but was unabb,to do so because, haying entered the premisgs and having'identified myself, I was: . ,i,: -? ..c,: - . 1. Q advised by . -- t11e1the respondent was not then present, and premises is reinter respor,denis actualplace of business no dwelGrg.houea __ 2. Q unable-to secure Identification of the person(s) present; - •- - - -r s:o r +. , -r . . . .. •.='E: 'T] ? TS3A

` 3. ❑ advised by - - —. mat no officer, airedor. managing agent or agent of respondent ootporation wee present ~.r a Thereupon, I delivered a copy of the herein Notice of Violation to - , _ . w..P - whom I believe to be an employee'of responders-at thepremises because: (check 1. 2 or 3) r - - -'~'-• oem - - - - - '_ .- - - _ _r 1. Q Employee so identified him/heraetf; -- - —

.2. Q Employee was performing work consistent with being employed by the respondent; or .. . . -- - _ _ -- -- . ---- --- -- - - .._ 3❑Other: •

,j. , :n_. .. 1 :.•?r Description of Individual. (This must be completed for all types of service eacept.corporate, Number Ill, above.) - -- -- - "-'"-'• r-i -.

Deponent describes the individual served as follows: - -—- — - - - -- - .. .. . :- ti . .- - --'-- _ .' _t Mate fl White Skin -~• . G 8lsck Hair, ' ' D 14.20. - -. . ❑ Under 5' - ' `OUridar 100 lbs- ❑ Female D Black Skin ❑ Brown Hair • - ' • Cl 21-35 — ---"— ❑ 5'0'•8'3' - ' - - /J100-130 .D Yellow Skin >'' D=Blond Hair ~- Cl 36-50 O 54"-5'6"'. s~ .- .'.c ureo s 0131.1%O fl d~'i. D Brown Skirl D Gray.Hair __ _ :. P 5-6 O 59'•6'0' ._' _" Q161.200_. D Red Skin O Red Hair: . O Over 65 O Over 6' _ O Over 200 T c:ea m _ _ O White Hair - . = .•x~-. '.

Other identifying characteristics: "' > _ •

Dry`V. - .'J:up.. , moo-

_— - . .?:':Si '1n- . "ii '4 .. c - _ _ -.- :t t.uR

Sworn to before me on 19_ r~,

. .. . - .Jv __ — sarwur.r a. eemrrwe - - .. ':-:.hit. . ..

It not sworn, this statement shall constitute a certificate of service. - ._ - -- - .. - - _ _ - _ _ ... - -- - _—_ _F.. . .,-O t.. jrcre' _ .''1 _ _-C.. . .. .___— _. . _. .. -' i i%- :

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NYC-WTC 000166189