Affidavit of Service on Corporation

[Caption]

State of New York

ss.:

County of __________

__________ [Name], being duly sworn, deposes and says:

1. That [he/she] is over 18 years of age and not a party to this action.

2. That [he/she] served the annexed Summons [with Notice/and Complaint] on the defendant, __________ [Name], by personally delivering to and leaving a true copy thereof with __________ [Name] at __________ [Address], on __________ [Date] at __________ [Time].

3. Deponent knew the corporation served to be the corporation described as the defendant in this action and the individual served to be the __________ [Title] of that corporation.

_______________________

Signature

Sworn to...