COURT COUNTY OF ...................................................... : : : Plaintiff(s) : : : : : Defendant(s) : ...................................................... STATE OF NEW YORK COUNTY OF ) ) ) Index No. AFFIDAVIT OF SERVICE (for Service of Papers Commencing an Action upon a Domestic or Authorized Foreign Corporation CPLR � 311 (a)(1) and (b) and BCL � 306) -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 corporation) (hereinafter referred to as the ''corporation''), a(n) (domestic/authorized foreign) (insert address where served or if no address, place of service) corporation, at by: (NOTE: YOU MUST COMPLETE SECTION DESCRIBING PHYSICAL CHARACTERISTICS OF PERSON SERVED (BELOW)) (a) personally delivering a true copy of the papers thereat to an (officer/director/managing agent/general agent/cashier/assistant cashier/agent) of the corporation authorized by appointment or law to receive service. I knew the corporation so served to be to be the corporation described in the said papers as the defendant, and the person who accepted the service on behalf of the corporation to be the said thereof. personally delivering to and leaving with the (secretary of state/secretary of state's deputy/person authorized by the secretary of state to receive such service) at the office of the Department of State in the City of Albany, duplicate true copies of such papers together I knew the corporation so served to be the corporation with the statutory fee of $ described in the said papers as the defendant, and the (secretary of state/secretary of state's deputy/person authorized by the secretary of state to receive such process) (b) to be the corporation's agent for service of process; 2003 � American LegalNet, Inc. www.USCourtForms.com (c) delivering a true copy of the papers thereat as directed by the court which was by 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 option that applies. 2003 � American LegalNet, Inc. www.USCourtForms.com