NYC 9/11 Public Portal Document
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AFFIDAVIT jeawWii or UiyW :llnU L [J..J
iK»n»jowA?i • 4 •< 0;:,3.;.
Slate o< New \brk, County of
The undersigned being
at
Hearing on the respondent named herein. : i
I. Individual; Personal Service .1...
n by delivering a true copy to said respondent personally. ‘J..1 .Libr^'L.j.blX —iLL . - . I . liJ ••
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II. Individual; Substituted Sorvico ;
Q by delivering a true copy to ------------------------- ---------■___ —
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4_ A person of sultablo ago and diacretion. Said promises is respondent's
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actual placa of business, dwelling house or usual place of abode within the State .
III. Corporation
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Q by delivering a true copy to. at aaU corporation.
TOST
IV. Delivery to Employee at Premlaes
Q by delivering a true copy to respondent's employee al the above location: (anawer A and B)
A. I attempted to personally serve the herein Notice of Violation on the respondent named herein bid was unable to do ao becauee, having entered the pramiaes and hawing Identified
myself, I was:
1. Q advisedby that ths respondent was not then preaenl, and premlaes is neWier leepondenHs actual place oi buelnees nor dwelling house.
2. Q unable to secure identification of the person(s) present;
a Q advised by _J_------------------------------ - thmnoI officer, direr^. managing agem or agent of
B. Thereupon, I delivered a copy of the heroin Notice of Violation to____ ‘'*'n KoflJ-R, _______
whom I believe to be an employee of respondent at the premises because: (chock 1, 2 or 3) (/
1. Q Employee so identified him/herself;
2. Q Employoe was performing work consistent with being employod by the respondent; or
a □ Other:______ _____________________________ _____________________________
Description of individual. (This must be completed lor all types of service except corpor^ Number III, above.) ^
Deponent describes the Individual served as foHcwzs:
•a White Skin □ Black Hair □ 14-20 □ Under S' □ Under 100 lbs
XL^rown Hair ;ih.nr
□ Female □ Black Skin □ 5'0'^’3' □ 100-130
^Blond Hair
□ Vallow Skin t-ifU , ,, Y, □ 131-180
□ Brown Skin □ Gray Hair - lilAi □ 61-86, ' .J’/'’’*’*’’ . . ■ ^181-200
□ Red Skin □ Red Hair □ Over 65 ^<Over6' □ Over 200
□ White Hair
□ Balding
Other identifying characterietice:
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Sworn to before me on
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* If not sworn, this statemeifi shall constitute a certificato of
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NYC-WTC_000168910
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