AFFIDAVIT OF SERVICE


Index No.:___________________Date Filed:__________________
Court::_____________________________________

Plaintiff/Petitioner:_____________________________________
Defendant/Respondent:_____________________________________

STATE OF NEW YORK, COUNTY OF KINGS  ss.:

(PROCESS SERVER'S NAME) , being duly sworn deposes and says:
I am not a party to this action; I am over (18) eighteen years of age;I reside in New York State.

On ________________at ________, I served the within SUMMONS AND VERIFIED COMPLAINT on JOHN DOE at
_______________________________________________in the manner indicated below:

[__] SUITABLE AGE. By delivering a true copy of each to _________________________________, a person of
suitable age and discretion. Said premises are the recipient's [_] actual place of business [_] dwelling house (usual
place of abode) within the state.

[__] MAIL COPY. Pursuant to CPRL-Section 3215(g)(3)(i), on __________________, deponent completed service by
depositing a true copy of each document to the above address in a 1st Class postpaid properly addressed envelope not
indicating that mailing was from an attorney or concerned legal action and marked " Personal and Confidential" in an
official depository under the exclusive care and custody of the United States Post Office in the State of New York.

A description of the Defendant, or the person served on behalf of the Defendant is as follows:





Other features: ________________________________________________________

[__]  MIL SRVC. Your deponent asked the person spoken to whether defendant was in the active military service of the
United States or New York State ; and received a  negative reply. Upon information and belief I have ;being based on
the conversations & observations above narrated, defendant is not in the military service.

[__] OTHER. Private house. No apartment number.


Sworn to before me on _________                                                    ___________________________________
                                                                                          PROCESS SERVER'S NAME
___________________________                                                     LIC ____________

Notary Public, Qualified in  ________
Commission Expires _____________
Sex
Color of skin
Color of Hair
Age
Height
Weight