Statement Of Service By Mail

SUPREME &2857 2) 7+( 67$7( 2) 1(: <25. 6835(0( &2817< 2) Index No.: Petitioner, -against- STATEMENT OF SERVICE BY MAIL AND ACKNOWLEDGMENT OF RECEIPT BY MAIL OF NOTICE OF PETITION AND PETITION Respondent. A. STATEMENT OF SERVICE BY MAIL 7R [Insert name and address of person or entity to be served] 7KH HQFORVHG notice of petition and petition DUH VHUYHG SXUVXDQW WR VHFWLRQ D RI WKH &LYLO 3UDFWLFH /DZ DQG 5XOHV 7R DYRLG EHLQJ FKDUJHG ZLWK WKH H[SHQVH RI VHUYLFH XSRQ \RX \RX PXVW VLJQ GDWH DQG FRPSOHWH WKH DFNQRZOHGJHPHQW SDUW RI WKLV IRUP DQG PDLO RU GHOLYHU RQH FRS\ RI WKH FRPSOHWHG IRUP WR WKH VHQGHU ZLWKLQ WKLUW\  GD\V IURP the date you rHFHLYH LW <RX VKRXOG NHHS D FRS\ IRU \RXU UHFRUGV RU \RXU DWWRUQH\ ,I \RX ZLVK WR FRQVXOW DQ DWWRUQH\ \RX VKRXOG GR VR DV VRRQ DV SRVVLEOH EHIRUH WKH WKLUW\  GD\V H[SLUH ,I \RX GR QRW FRPSOHWH DQG UHWXUQ WKH IRUP WR WKH VHQGHU ZLWKLQ WKLUW\  GD\V \RX RU WKH SDUW\ RQ ZKRVH EHKDOI \RX DUH EHLQJ VHUYHG ZLOO EH UHTXLUHG WR SD\ H[SHQVHV LQFXUUHG LQ VHUYLQJ WKH VXPPRQV DQG FRPSODLQW RU VXPPRQV DQG QRWLFH RU QRWLFH RI SHWLWLRQ DQG SHWLWLRQ LQ DQ\ RWKHU PDQQHU SHUPLWWHG E\ ODZ DQG WKH FRVW RI VXFK VHUYLFe aV SHUPLWWHG E\ ODZ ZLOO EH HQWHUHG aV D MXGJPHQW DJDLQVW \RX ,I \RX KDYH UHFHLYHG D FRPSODLQW RU SHWLWLRQ ZLWK WKLV VWDWHPHQW WKH UHWXUQ RI WKLV VWDWHPHQW DQG DFNQRZOHGJHPHQW GRHV QRW UHOLHYH \RX RI WKH QHFHVVLW\ WR DQVZHU WKH FRPSODLQW RU SHWLWLRQ 7KH WLPH WR DQVZHU H[SLUHV WZHQW\  GD\V DIWHU WKH GD\ \RX PDLO RU GHOLYHU WKLV IRUP WR WKH VHQGHU ,I \RX ZLVK WR FRQVXOW ZLWK DQ DWWRUQH\ \RX VKRXOG GR VR DV VRRQ DV SRVVLEOH EHIRUH WKH WZHQW\  GD\V H[SLUH ,I \RX DUH VHUYHG RQ EHKDOI RI a cRUSRUDWLRQ XQLQFRUSRUDWHG DVVRFLDWLRQ pDUWQHUVKLS RU RWKHU HQWLW\ \RX PXVW LQGLFDWH XQGHU \RXU VLJQDWXUH \RXU UHODWLRQVKLS WR WKH HQWLW\ ,I \RX DUH VHUYHG RQ EHKDOI RI DQRWKHU SHUVRQ DQG \RX DUH DXWKRUL]HG WR UHFHLYH SURFHVV \RX PXVW LQGLFDWH XQGHU \RXU VLJQDWXUH \RXU DXWKRULW\ ,W iV D FULPe to forge a signature or to make a false entry on this statement or on the DFNQRZOHGJHPHQW 'DWHG [City, State] [Date] StatePHQW RI 6HUYLFH E\ 0DLO per CPLR 312-a as of 4/12/12 American LegalNet, Inc. www.FormsWorkFlow.com % $&.12:/('*0(17 2) 5(&(,37 2) NOTICE OF PETITION AND PETITION I received a notice of petitionand petition in the above-captioned matter at notice of pettion and petition LQVHUW DGGUHVV 3/($6( &+(&. 21( 2) 7+( )2//2:,1* ,) ,6 &+(&.(' &203/(7( $6 ,1',&$7(' am not in military service. I am in military service, and my rank and branch of service are as follows: Rank: Branch of service: TO BE COMPLETED REGARDLESS OF MILITARY STATUS: Date: __________________________ (Date this Acknowledgment is executed) I affirm the above as true under penalty of perjury. _____________________________________ Signature _____________________________________ Print name _____________________________________ Name of Respondent/Defendant for which acting Position with Respondent/Defendant for which acting (i.e., officer, attorney, etc.) _____________________________________ PLEASE COMPLETE ALL BLANKS INCLUDING DATES $FNQRZOHGJPHQW RI 6HUYLFH E\ 0DLO per CPLR 312-a as of 4/12/12 American LegalNet, Inc. www.FormsWorkFlow.com