CIVIL COURT OF THE CITY OF NEW YORK County of Part
Index No. AFFIDAVIT OF SERVICE OF SUMMONS WITH ENDORSED COMPLAINT (Personal Delivery)
Plaintiff(s) -against-
Defendant(s) State of New York, County of ss: , being duly sworn, deposes and says:
(Name of Server)
I am over 18 years of age and not a party to this action. At
(Time)
AM/PM, on
(Date) (Name of County)
at
(Address)
in the County of
, City of New York, I served the attached
SUMMONS WITH ENDORSED COMPLAINT in this matter on
(Name of Defendant as shown above)
by delivering the said SUMMONS to:
(Name of actual person with whom the SUMMONS was left)
the said defendant in person, or known to me to be the
(Title)
of the
(Corporation/Partnership)
Description of Individual Served in Person: Sex: Approximate Age: Color of Skin: Approximate Weight:
Color of Hair:
Approximate Height:
Sworn to before me this
day of
20
(Signature of Deponent)
(Notary Public or Court Employee and Title)
CIV-GP- 1 8-1 (Revised 5/04) FREE CIVIL COURT FORM No fee may be charged to fill in this form. Form can be found at: http://www.nycourts.gov/courts/nyc/civil/forms.shtml.