SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF X Plaintiff(s)/Petitioner(s), - vs - AFFIDAVIT OF SERVICE OF INITIATING PAPERS Index No.: STATE OF NEW YORK COUNTY OF I, Defendant(s)/Respondent(s). X ) ) ss.: , being duly sworn, depose and say: I am over eighteen (18) years of age, am not a party to this action, and reside at: . That on , 20 , at on a.m. p.m., I served a copy of the within . The address of the place . where the papers were served is: I served the papers in the manner indicated below (check 1, 2 or 3): 1. Individual By delivering a true copy thereof to personally. I knew the person served to be the person named in those papers because: . 2. Corporation By serving the above on , a domestic corporation, by delivering a true copy thereof to , who is the . I knew the corporation to be that listed in the papers served and I knew the title of the person named above and that he/she was authorized to accept service. 3. Substituted Service By delivering a true copy thereof to , a person of suitable age and discretion, at the actual place of business, dwelling house, or usual place of abode in the state, and mailing, as indicated below. American LegalNet, Inc. www.FormsWorkFlow.com Mailing (use with 3 above) I also enclosed a copy of the above papers in a postpaid, sealed envelope properly addressed to Defendant's last known residence or actual place of business, located at: . I deposited the envelope in a post office depository under the exclusive care and custody of the United States Postal Service within New York State. Description (use with 1, 2, or 3 above) The individual I served had the following characteristics (check the appropriate boxes): Sex: Male Female Age: 21 - 34 years 35 - 50 years 51 - 61 years Over 61 yrs. Height: Under 5' 5'0'' to 5'3'' 5'4'' to 5'8" 5'9'' to 6'0" Over 6' Weight: Under 100 lbs. 100-130 lbs. 131-160 lbs. 161-200 lbs. Over 200 lbs. Color of skin (describe): Color of hair (describe): Other identifying features, if any (describe): Military Service I asked the person to whom I spoke whether the Defendant was in the military of the United States or New York State in any capacity and was told that he/she was not. Defendant did not wear a military uniform. I state upon information and belief that the Defendant is not in the military service of the United States or New York State. The basis for my belief is the conversation(s) and observation(s) described above. Signature Print Name Sworn to before me this , 20 day of . Notary Public American LegalNet, Inc. www.FormsWorkFlow.com