_____________________________________________ COURT __________________________________ COUNTY OF ...................................................... : Index No. : : Plaintiff(s) : : : : : Defendant(s) : ...................................................... STATE OF NEW YORK COUNTY OF ) ) ) AFFIDAVIT OF SERVICE (for Service of Papers Commencing Action upon Court, Board or Commission CPLR � 312) -against- ss.: The undersigned, being duly sworn, deposes and says; 1. I am not a party to the within action; 2. I am over eighteen (18) years of age; 3. I reside at 4. That on (insert date and time of service) I served the within (summons and complaint/third-party summons and complaint/summons with notice/petition/notice of petition/order to show cause *) (hereinafter referred to as the "papers" on the defendant (insert name of defendant court, board or commission) (hereinafter referred to as the "court'', "board" or "commission" as the case may be) at (insert address where served or if no address, place of service) by: (NOTE: YOU MUST COMPLETE SECTION DESCRIBING PHYSICAL CHARACTERISTICS OF PERSON SERVED (BELOW)) (a) (if court consisting of three or more judges) personally delivering a true copy of the papers thereat one of the judges of the to court. I knew the court so served to be the defendant described in the said papers, and the judge who accepted service on behalf of the court to be one of three or more judges of the said court. (b) (if board or commission having a chairman or other presiding officer, director or clerk) personally delivering a true copy of the papers thereat to the (chairman/presiding officer/director/clerk of the knew the so served to be the defendant described in the said papers and the person who accepted service on behalf of the (board/commission) to be the said thereof. (board/commission) board/commission) _____________________________________________________________ I American LegalNet, Inc. www.FormsWorkflow.com (c) personally delivering a true copy of the papers thereat to the clerk of the (town/village) I knew the (board/commission) of the (town/village) to be the defendant described in the said papers, and the person who accepted service on behalf of the (board/commission) to be the said clerk of the (town/village) (if board or commission of a town or village) (if board or commission other than one specified in (b) or (c), above) personally (d) delivering a true copy of the papers thereat to . I knew the (board/commission) one of the members of the (board/commission) so served to be the defendant described in the said papers, and the person to be one of who accepted service on behalf of the said (board/commission) the members thereof. Physical Description of Person Served: Gender: Male/Female Skin color: Hair color/Bald/Balding: Facial Hair, if any: Approximate age: Approximate height: Approximate weight: Other identifying features, if any (ex. eyeglasses, scars, etc.) (Sign above and type or print name below) License No. Sworn to before me on this day of , 20 Notary * All words in italics contained in this document indicate options. Choose the option that applies. American LegalNet, Inc. www.FormsWorkflow.com