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268-Summons: Civil Court: endorsed summons or annexed complaint,Uniform Rules, 22 NYCRR 208.6(b)., 10-94 www.blumberg.com

CIVIL COURT OF THE CITY OF NEW YORK,COUNTY OF Index No.

Summons

Plaintiff‘s Residence

The basis of the venue designated is:

against

Defendant(s)

To the above named defendant(s)

You are hereby summoned to appear in the Civil Court of the City of Newat the office of the said court at

City and State of New York, within the time provided by law

together with the costs of this action.

York, County of

in the County ofas noted below and to file your answer to the-endorsed summons-annexed complaint*-with theClerk: upon your failure to answer, judgment will be taken against you for the sum of $with interest thereon from

Dated,

Defendant's Address:Attorney(s) for Plaintiff

Post Office Address and Telephone Number

NOTE: The law provides that: (a) If this summons is served by its delivery to you personally within the City ofNew York, you must appear and answer within TWENTY days after such service; or

(b) If this summons is served by delivery to any person other than you personally, or is served outside theCity of New York, or by publication, or by any means other than personal delivery to you within the City of NewYork, you are allowed THIRTY days after proof of service thereof is filed with the Clerk of this Court withinwhich to appear and answer.*If the cause of action is for money only and a formal complaint is not attached to the summons, strike the words “annexedcomplaint". If a formal complaint is attached to the summons, strike the words “endorsed summons".

ENDORSED COMPLAINTA statement of the nature and substance of the plaintiff's cause of action is as follows:

Attorney(s) for Plaintiff(s)

Address:Plaintiff(s)}

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AFFIDAVIT OF SERVICESTATE OF NEW YORK, COUNTY OF SS: The undersigned, being duly sworn, deposes and says; deponent is not aparty herein, is over 18 years of age and resides atThat on at M., atdeponent served the within summons, and complaint on defendant therein named,

by delivering a true copy of each to said defendant personally; deponent knew the person so served to be the person described asINDIVIDUAL

I. said defendant therein.

2. personally, deponent knew said corporation so served to be the corporation described in said summons as said defendant andknew said individual to be thereof.

SUITABLE AGE PERSON by delivering thereat a true copy of each to a person of suitable age3. and discretion. Said premises is defendant’s-actual place of business-dwelling place-usual place of abode-within the state.

AFFIXING TO DOOR , ETC. by affixing a true copy of each to the door of said premises, which is defendant’s-actual place of business-dwelling place-4. usual place of abode-within the state. Deponent was unable, with due diligence to find defendant or a person of suitable age

and discretion thereat, having called there

CORPORATION a corporation, by delivering thereat a true copy of each to

MAlLlNG TORESIDENCEUSE WITH 3 OR 4

5A.

MAILING TOBUSINESS

USE WITH 3 OR 4

5B.

DESCRIPTIONUSE WITH1,2,OR 3

Within 20 days of such delivery or affixing, deponent enclosed a copy of same in a postpaid envelope properly addressed todefendant at defendant’s last known residence, at and depositedsaid envelope in an official depository under the exclusive care and custody of the U.S. Postal Service within New York State.Within 20 days of such delivery or affixing, deponent enclosed a copy of same in a first class postpaid envelope properlyaddressed to defendant at defendant’s actual place of business, at

in an official depository under the exclusive care and custody of the U.S. Postal Service within New York State.The envelope bore the legend “Personal and Confidential” and did not indicate on the outside thereof, by return addressor otherwise, that the communication was from an attorney or concerned an action against the defendant.

Male White Skin Black Hair White Hair 14-20 Yrs. Under 5’ Under 100 Lbs.Female Black Skin Brown Hair Balding 21-35 Yrs. 5’0”-5’3” 100-130 Lbs.

Yellow Skin Blonde Hair Mustache 36-50Yrs. 5’4”-5’8” 131-160 Lbs.Brown Skin Gray Hair Beard 51-65Yrs. 5’9”-6’0” 161-200 Lbs.Red Skin Red Hair Glasses Over 65 Yrs. Over 6’ Over200 Lbs.

Other identifying features:

Sworn to before me onPrint name beneath signature.

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