Affidavit Of Service Of Proposed Poor Persons Order

STATE OF NEW YORK SUPREME COURT COUNTY OF ___________________________ =================================== Plaintiff, - against - Index No. RJI No.: , AFFIDAVIT OF SERVICE OF PROPOSED POOR PERSON'S ORDER , Defendant. =================================== STATE OF NEW YORK ) ) COUNTY OF __________________ ) SS.: ______________________, residing at _________________________, being sworn, says, I am not a party to the action, and am over 18 years of age. On ___________, I served a copy of the Summons with Notice or the Summons and Verified Complaint, and the Affidavit In Support Of Application To Proceed as a Poor Person , income verification and proposed Poor Person Order upon Defendant at the address designated by Defendant and upon: (check which box applies): The (insert name of County)_____________ County Attorney OR The Corporation Counsel of the City of New York by depositing a true copy thereof enclosed in a post-paid wrapper, in an official depository under the exclusive care and custody of the U.S. Postal Service within New York State, addressed to : ___________________________________________________________________________ ___________________________________________________________________________, Server's Dated: ________________ Signature: _____________________________ Print Name: _____________________________ SWORN to before me on this ____ day of , 20____. NOTARY PUBLIC Eff. 1/25/16 American LegalNet, Inc. www.FormsWorkFlow.com