AFFIDAVIT / CERTIFICATE OF SERVICE

Caption Example

SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF [COUNTY]

[PLAINTIFF NAME],
Plaintiff,

v. Index No. [INDEX NUMBER]

[DEFENDANT NAME],
Defendant.

Declarant Information

[NAME OF DECLARANT], being duly sworn, deposes and says:

1. I am over 18 years of age and not a party to this action. My business/residential address is [ADDRESS].
2. On [DATE OF SERVICE], I served the [TITLE OF DOCUMENT SERVED] upon the recipients listed below in the manner indicated, pursuant to CPLR 2103 and Uniform Rule 202.5-b.

Recipients and Methods

• Recipient: [NAME]
• Capacity: [E.G., "Attorney for Defendant"]
• Service Address/Email: [CONTACT INFORMATION]
• Method(s) of Service:
• ☐ NYSCEF electronic service (registered e-filer)
• ☐ Electronic mail (consent filed pursuant to CPLR 2103(b)(7))
• ☐ Personal service
• ☐ First-Class Mail
• ☐ Overnight delivery service (CPLR 2103(b)(6))
• ☐ Certified Mail / Return receipt requested
• Time of Service: [TIME]

[Repeat bullet list for each additional recipient.]

Additional Details

• NYSCEF Confirmation Notice ID: [ID].
• Mailing/overnight delivery initiated at [CITY, STATE].
• If service on a non-NYSCEF participant was required, documents were delivered per CPLR 2103(b)(1): [DETAILS].

Affirmation / Affidavit

☐ Affirmation (for attorneys): I affirm the foregoing statements under penalty of perjury.

☐ Affidavit (for non-attorney server):

______________________________
[NAME OF SERVER]
Sworn to before me this ___ day of __________, 20__.

______________________________
Notary Public, State of New York
Qualified in [COUNTY]
Commission Expires: __________
If submitted as an attorney affirmation, include signature block:

[NAME OF SERVING ATTORNEY]
[NEW YORK ATTORNEY REG. NO.]
[FIRM NAME]
[ADDRESS]
[PHONE]
[EMAIL]
Attorney for [PARTY]

Practitioner Notes

• Ensure compliance with 22 NYCRR 202.5-b(h) for e-filing service on nonparticipating parties.
• Retain NYSCEF confirmation emails and printouts for inclusion in motion papers.
• When serving orders to show cause, follow any special directives in the signed order regarding service.