AFFIDAVIT OF SERVICE - PERSONAL SERVICE - INDIVIDUAL STATE OF NEW YORK } ss: COUNTY OF SUFFOLK } I, , being duly sworn, deposes and says: Print your na me I reside at: , Insert your complete address and am over 18 years of age, and not a party to this action. On the day of , 20 , at oclock in the inse rt date insert month year hour FORE NOON AFT ERNOON , I served the within Strike out the inappropriate phrase Insert the name of the documents served, i.e., the summons, complaint, order, etc. Attach a copy of the document to this Affidavit of Service upon , known to me to be the defendant named therein insert defendan ts name he re by delivering to and leaving with HIM HER personally, at Strike out insert the address where you served the defendant Town of , County of Suffolk, State of New York, a true copy thereof. Insert Town where you served the defendant Said individual had the following characteristics: Sex: color of skin: color of hair: approximate age: approximate weight: approximate height: other distinguishing characteristics: Your Signatu re Sworn to before me on this day of , 20 Day Month Year Notary/Clerk of Court Affidav it of Ser vice o n Def end ant by PERSONA L SERVI CE American LegalNet, Inc.DC-149R (05/ 03) www.USCourtForms.com