UNITED 
STATES 
COURT 
OF 
APPEALS 
FOR 
THE 
SECOND 
CIRCUIT 


U.S.c.A. 
Docket 
No. 
CERTIFICATE 
OF 
SERVICE 

V. 
(Case 
Caption) 

I, 
hereby 
certify 
under 
the 
penalty 
of
perjury 

that 
on 
the 
dayof 
_ 
DAY 
MONTH YEAR 
served 
by 
United 
States 
Mail 
or 
hand 
delivery 
the 
_ 

(Name 
of
DOCUMENT: 
Motion, 
Brief, 
Letter, 
etc.) 
on 
the 
following: 

Name 
Name 

Address 
Address 

SIGNATURE