Affidavit Of Personal Service
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1STATE OF NEW YORK
CITY/DISTRICT/TOWN/VILLAGE COURT
(1)
COUNTY OF
(2)
(4)
Index/Docket No.
(3)
Petitioner(s)/Landlord(s)
AFFIDAVIT OF PERSONAL SERVICE
-against-
(5)
Respondent(s)/Tenant(s)
State of New York
County of
ss.:
City/Town Village of
(6)
(7)
(8)
, being duly sworn, deposes and says
that (s)he served the (9)
In the above entitled action upon the following nam ed respondent(s) at the following place(s) and tim e(s):
(10) TENANT NAME(S)
(11) ADDRESS (CITY/TOW N/VILLAGE) & STATE
(12)TIME & DATE
by delivering to and leaving with respondent(s), personally, a true copy thereof, and deponent further says
that (s)he knew the person so served to be the sam e person m entioned and described in the said
sum m ons as respondent therein, and that at the tim e of m aking such service deponent was over eighteen
years of age and not a party to this action. That (s)he asked respondent whether respondent was in the
m ilitary service of the United State Governm ent, in any capacity whatever, and respondent replied (s)he
was not. Respondent was clad in ordinary civilian clothes and wore no m ilitary uniform of any kind.
(13) The person served is described as follows:
Sex
, Color of Skin
, Hair Color
, Approxim ate: Age
,
W eight
, Height
. Other identifying features:
(14)
(15)
Sworn to before me this
day
(Signature)
of
, 20
)
(Print or Type Name
Notary Public
LT-H-APS 9-07
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