Form A-10 - Affidavit of service of citation
STATE OF NEW YORK
SURROGATE'S COURT: COUNTY OF ________
Note: File Proof of Service at least 2 days before return date. State clearly date, time and place of service and name of person served (Uniform Rules 207.7(c))
________x
ADMINISTRATION PROCEEDING
Estate of ________ AFFIDAVIT OF SERVICE OF
CITATION (Adult)
a/k/a
________ Deceased. File No.________
________x
STATE OF NEW YORK )
) ss.:
COUNTY OF ________ )
________ of ________, being duly sworn, says that I am over the age of eighteen years; that I made personal service of the citation herein dated ________, 19________, on each person named below, each of whom deponent knew to be the person mentioned and described in said citation, by delivering to and leaving with each of them personally a true copy of said citation, as follows:
On ________, description, viz: sex ________, color of skin ________, color of hair ________, approximate age ________, weight ________, height ________, at ________ o'clock ________.m. on the ________ day of ________, 19________, at ________.
On ________, description, viz: sex ________, color of skin ________, color of hair ________, approximate age ________, weight ________, height ________, at ________ o'clock ________.m. on the ________ day of ________, 19________, at ________.
On ________, description, viz: sex ________, color of skin ________, color of hair ________, approximate age ________, weight ________, height ________, at ________ o'clock ________.m. on the ________ day of ________, 19________, at ________.
That none of the aforesaid persons is in the Military Service as defined by the Act of Congress known as the "Soldiers' and Sailors' Civil Relief Act of 1940" and in the New York "Soldiers' and Sailors' Civil Relief Act."
________
Sworn to before me this
________ day of ________, 19________.
_________
Notary Public
Commission Expires: ________
(Affix Stamp or Seal)