Free Affidavit of Compliance with VTL 253 - New York

CIVIL COURT OF THE CITY OF NEW YORK County of Part Claimant(s)/Plaintiff(s), -against-

Index No.: AFFIDAVIT OF COMPLIANCE WITH VTL 253

Defendant(s) State of New York, County of ss: , being duly sworn, deposes and says: A copy of the Summons and Complaint has been sent/delivered to the Secretary of State (as evidenced by the receipt from the Secretary of State attached) and notice of such service on the Secretary of State and a copy of the Summons and Complaint were sent to the Defendant by Certified Mail a. b. as evidenced by the Return Receipt provided with this Affidavit. which was refused by said Defendant, as evidenced by the original envelope bearing a notation by the postal authorities that receipt was refused provided with this Affidavit. I further state that notice of such mailing and refusal (a letter explaining what has occurred) was forthwith sent to the Defendant by ordinary mail. which was unclaimed by said Defendant, as evidenced by the original envelope bearing a notation by the postal authorities that it was unclaimed provided with this Affidavit. I further state that the Summons was posted again by ordinary mail as evidenced by the Proof of Mailing Certificate from the postal authorities provided with this Affidavit. day of 20

c.

Sworn to before me this Sign your name Print Your Address

Signature of Court Employee and Title or Notary Public

CIV-GP-73 (Reverse) (revised 11/04)-i
FREE CIVIL COURT FORM No fee may be charged to fill in this form. Form can be found at: http://www.nycourts.gov/courts/nyc/civil/forms.shtml.