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FORM 5

AFFIDAVIT OF SERVICE BY MAIL

STATE OF NEW YORK:
:ss.
COUNTY OF _______:

 

__________________ being duly sworn, deposes and says that he/she is over the age of eighteen years and is not a party in this proceeding; that on the _____________ day of ________ 20___, deponent served the within ____________ upon ___________ in this action, at _______________, the address designated by ______________ for that purpose by depositing a true copy of the same by mail, enclosed in a post-paid properly addressed wrapper, in __________ a post office ___________official depository under the exclusive care and custody of the United States Post Office Department.

 

_________________________
Signature    

Subscribed and sworn to

before me this ____ day of

_________________ 20 ____

 

______________________________
(Signature of notary public)