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Process Serving Agency Compliance Plan Affirmation - Nyc Department Of Consumer Affairs

42 Broadway

PROCESS SERVING AGENCY

New York, NY 10004

COMPLIANCE PLAN AFFIRMATION

Dial 311

(212-NEW-YORK)

nyc.gov/dca

Process Serving Agency Name:

Process Serving Agency

DCA License Number

(if applicable):

Business Address:

I affirm the following:

1. I am authorized (e.g., owner, sole proprietor, general partner,

director, corporate officer, or shareholder owning 10% or more of

company stock) to complete and sign this affirmation on behalf of

the Process Serving Agency named above.

2. The Process Serving Agency named above has adopted a

written Compliance Plan to ensure that each individual serving

process on behalf of the Agency acts with integrity and honesty

and complies with the recordkeeping requirements applicable to

process servers.

3. I understand that falsification of any statement made herein is an

offense punishable by a fine or imprisonment or both.

_______________________________

Signature

Print Name

_______________________________

Position/Title

Date

Process Serving Agency Compliance Plan Affirmation - Nyc Department Of Consumer Affairs