Civil Court of the City of New York
County of Index Number
Plaintiff(s), -against-
AFFIDAVIT OF SERVICE OF JUDGMENT WITH NOTICE OF ENTRY
Defendant(s),
State of New York County of
~ss: , being duly sworn, deposes and says:
(Print Name of Deponent) 1) I am over the age of 18 and not a party to this action. 2) On the day of 20 I served a copy of the attached Judgment
with Notice of Entry on:
(Na m e) by putting it in a stamped envelope and mailing it to:
(A ddr es s)
(City, State, Zip)
(Signature of Deponent) Sworn to before me this of 20 day
(Notary Public) CIV-GP-106(12/03)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.