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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)

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