Fire Safety Plan, 7 World Trade Center, April 1988

NYC 9/11 Public Portal Document

AFFIDAVIT (CERTIFICATE*) OF SERVICE

State of New York, County of ) ss;

The undersigned being duly sworn* deposes and says: That deponent is not a party to the action and is over 18 years of age; Thal on 19. at AM/PM □ATE “riME

at __ deponent served the within Notice of Violation and LOortON

Hearing on the respondent named herein.

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

It. Individual; Substituted Service [2] by delivering a true copy to ____ , a person of suitable age and discretion. Said premises is respondent's NAME

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

III. Corporation Q by delivering a true copy to. at said corporation. NAME POSITfON

IV. Delivery to Employee at Premises [~~1 by delivering a true copy to respondent's employes 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 unable to do so because, having entered the premises and having identified myself, I was: O advised by ...... - that the respondent was not then present, and premises is neither respondent's actual place of business nor dwelling house. NAME

2. Q unable to secure identification of the person(s) present; 3- D advised by ___ that no officer, director, martaging agent or agent of respondent corporation was present. NAME

8, Thereupon, I delivered a copy of the herein Notice of Violation to 'name POSITION whom I believe to be an employee of respondent at the premises because: (check 1, 2 or 3) T ! I Employee so identified him/herself;

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

3. [2] other:_________ _ ___________________________________

Description of Individual. (This must be completed tor all types of service except corporate. Number 111, above ) Deponent describes ths Individual served as follows:

J Male n White Skin ; i Black Hair ' : 14-20 ri Under 5' n Under 100 lbs u Female n Black Skin : Brown Hair r ' 21-35 n S'O'-S'S" [J 100-130 □ 'fellow Skin I I Blond Hair r 36-50 n SM'-S'S" □ 131-160 □ Brown Skin n Gray Hair : i 51-65 n 5'9"-6'0" n 161-200 □ Red Skin J Red Hair i ' Over 65 □ Over 6' ! i Over 200 !1 White Hair n Balding

Other identifying characteristics: ......

SIGNATURE

PRINT NaST

T3fx'RE5i2i

Sworn to before me on 19.... .

SfQNATURE OF CERTIFYING OFFICER...

‘ If not sworn, this statement shaft constitute a certificate of service

NYC-WTC_000168876