NYC 9/11 Public Portal Document
yuuh.M? -it-! 'o=»‘ I
(CsirriTOimnOFMSWtfci^'
tp ni Naw York County o! ss
Kjrn’ deposes and says 'That deponent is not £paV> loHtye-action and is qwr 18 yea^ -...w. 4^ at _ . AM/PM
• 'N on the
ts I-
ihaeni named herein
t<..M deponent served the within Notice ol Violation and
.-1
nrjividual: Personal Service ,
_J by delivering a true rxjpy Io said lasfxjndenl personally.
ndividual: SubstHutod Service
by delivering a nue copy Io „ . a peraon of suitable age and discretion. Said premises is respondent's
NAK
actual place of business, dwelling house or usual place ol abode within the State.
by <’«!. . ort! at satU corps-iritio’:
iyeiivery to Employee ui Pr^miaes
by • (" r.ooy rr, res(x)iidenl's employee al the above location (answer A and B)
; j-.iui!ip.ec serve the hereie Notice of Violation on the respondent named herein but was unable to do so because, having entered the premises and having identified
myselt, I was.
■ . » i
1 [73 advised by ______ that the respondent was not then present, and premises is neither respondent's actual place of business nor dwelling house
j unable to socur© sdenlificalion cl the oerson(s) present;
3 } ■ f»cvi!>0d by f that no officer, director, managing agent or agent of ident corporation was present.
------- ' ................... NAME-'
Thereupon i rtehverec a copy ot the herein Notice of Violation to
*wsjsiosr
-’.•hem 1 b©hev6 Tf oe an «mp;nya© hi respondent at the premises because, (check 1, 2 or 31 (
employee sc. identified him/neisall.
2. I I Employee was performing work consistent with being employed by the respondent; or
3. ! Other-
. - .‘-ci- ?■>. • -v
criptlon of Individual. (This must be completed for all types 'rvice except corporate. Number III. above.)
■rr.i describes me individual served as follows
'-'^Willie Sk:ri Black Hair , , 14-20 i Under S’ . , Under lOC lbs
'--'2 * l3lack Skm Brown Hair ■ 21-35 . ■ 5'0"-5'3'’ : 100130
lond Hair ; 3^-50 5'4"-5’8" ■ , 131-160
Brown Skin ^ray Hair ><51-65 ; 5'9'’.6’0” ^<161-200
Red nk'd Red Hair "■ Over 65-' i>^ver 6' ■ Over 200
i While Hair
Balding
c wbarac-
< /
r'/'
‘-jL
PH
;c ceforc me c i
td-___
SiwouHt Of cemtFXNG o^setS
sworn, this statement shall constitute a certificate of service.
rt.
NYC-WTC_000168811
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