UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK (List the name(s) of the plaintiff(s)/petitioner(s).) ____ Civ. ___________ (_____) (_____) - against - AFFIRMATION OF SERVICE (List the name(s) of the defendant(s)/respondent(s).) I, (print your name) , declare under penalty of perjury that I served a copy of the attached (list the names of the documents you served): upon all other parties in this case by (state how you served the documents, for example, hand delivery, mail, overnight express) ________________________________________________________ to the following persons (list the names and addresses of the people you served): on (date you served the document(s)) ___________________________ Dated . Signature Address City, State Zip Telephone Number E-Mail Address Rev. 01/2013 American LegalNet, Inc. www.FormsWorkFlow.com