NYC 9/11 Public Portal Document
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KOOAjiesv I
aWfRAjlK (JM®.
atate^of New York. County of
luiiiia''; Mioy ^.sin
The undersigned being duly ^rn' deposesand sa^: ThatideponenuLn^ a ^rW to (he tia!^Pdj^6rJ?ye)arso(age,Tha!o|ttZK al----- ,^_AM;pM
' at _?aBj^n^nt sOiyW the within Notice of Violation and
i Hearing on the respondent nampd herein. , j j IX
I. Individual; Personal Service c □ □ it;®. : J
Q by delivering a true copy to said respondentipei^nfely,?.
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II. Individual; Substituted Service,
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o by delivering a true copy to X .|a perspn of suitable age and discretion; Said premises is respondent's
, . -i___ ; . ,.,t ' - ' - ' \ • •:
actual place of business, dwelling house or i^suaf place of apode withiy fhfl State, ;
Hi. Corporation
' Q'by delivering, e |rpe copy ’to^_. at said corporation.
• HlMt- po«n»G>w - ?
't vd 0 'vi
IV.''i«WiW“toWor4aW
I I by delivering a true copy to respondent’s employee at the above location: (answer A and B)
a; I atiempted to personally servts tfte herein Notice ofWidlafion on the respondent named herein but was unable to do so because, having entered the premises and haying identified
myself, I was:' .... .<....... -< '
1. Q advised by that the respondent was not then present, and premises is neither respondent's actual place of business nor dwelling house.
NAME
1
g. □ unaWe to secure identification ol the jjaisoals) present;
U-,. ..ti ",
a-D advised by NAME
that no manning ^^i^agept p< responden^^rt ^ ii^as present.
whom I believe to be an employee of respondent al the premises because: (check 1, 2 or 3)
1. □ Employee so identified him/harselt, . _
2. bO Employee vlife'^fftii'mlnjf’ferlr dohaiii^ehf with being employed by the respondent; or '
3.
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Description of Individual. (This must be completed for all types of serVfCe-except corporate. Number III, above.)
Deponent describes ttie individual served as followsi o: :
^ale ^^hite.Skin.,
.. q.Bieck Hair 14-20 n Under 5' □ Under 100 lbs
□ Female 6 Black Skin □ ’BftfwITHair '□21-35 □ 100-130
,, ftW^Skin ,,n ' ‘ X' D 131-163" '
ns'O'^'O" "’ ” ^161-200
L) Brown Skin MGray Hair ■ -1fcl-65 ;
□ Red Skin iBRedSHMir '• ; .’IUH fl Over 65 □ Over 200 ,
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Other identifying characteristics:
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• If not sworn, this statement shall'cdi^tituitf’^l^Hlfi(:te^
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NYC-WTC_000168851
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