_____________________________________________ COURT __________________________________ COUNTY OF ...................................................... : Index No. : : Plaintiff(s) -against AFFIDAVIT OF SERVICE (for Service of Papers Commencing Action upon Governmental Subdivision CPLR § 311 (a)(2)-(8) and (b)) : : : : : Defendant(s) : ...................................................... STATE OF NEW YORK COUNTY OF ) ) ) 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 governmental subdivision) (hereinafter referred to as the type of governmental subdivision i.e. "city", "town", "village" etc., 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 the defendant is the City of New York) personally delivering a true copy of the papers thereat to (at the corporation counsel/the person designated to receive process in a writing filed in the office of the clerk of New York County) . I knew the city so served to be the city described in the papers as the defendant, and the person who accepted service on behalf of the city to be the thereof; (b) (if the defendant is any city other than the City of New York) papers thereat to personally delivering a true copy of the the (mayor/comptroller/treasurer/ counsel/clerk/officer (performing a corresponding function under another name) __________________ ____________________________________ of the city. I knew the city so served to be the city described in the papers as the defendant, and the person who accepted service on behalf of the city to be the ____________________________________________________hereof; American LegalNet, Inc. www.FormsWorkflow.com (c) (if the defendant is a county) personally delivering true copy of the papers thereat to (the chair or clerk of the board of supervisors/clerk/attorney/treasurer) of the county. I new the county so served to be the county described in the papers as the defendant, and the person who accepted service on behalf of the county to be the thereof; (if the defendant is a town) personally (d) delivering a true copy of the papers thereat to the (clerk/supervisor) of the town. I knew the town so served to be the town described in the papers as the defendant, and the person who accepted service on behalf of the town to be the thereof; (if the defendant is a village) personally (e) delivering a true copy of the papers thereat to the (mayor/clerk/trustee) __________ of the village. I knew the village so served to be the village described in the papers as the defendant, and the person who accepted service on behalf of the village to be the thereof, (if the defendant is a school district) (f) personally delivering a true copy of the papers thereat to a school officer of the school district. I knew the school district so served to be the school district described in the papers as the defendant, and the person who accepted service on behalf of the school district to be the school officer thereof; (g) delivering a true copy of the papers thereat to ________________________________ a (clerk//trustee/member of the board) ________ . I knew ________________ of the (park/sewage/type of other district) so served to be the school district the (park/sewage/type of other district) described in the papers as the defendant, and the person who accepted service on behalf to be the of the (park/sewage/type of other district) thereof; delivering a true copy of the papers thereat as directed by the court which was by (if the defendant is a park, sewage or other district) personally (h) 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.): ___________________________________________ _________________________________________________________________________ Sworn to before me on this of , 20 day (Sign above and type or print name below) License No. Notary * All words in italics contained in this document indicate options. Choose option that applies. American LegalNet, Inc. www.FormsWorkflow.com