I am filling out an affidavit of personal service, "Form D," found at http://www.sro.nysed.gov/forms/default.html

The fill-in-the-blanks parts look pretty straightforward. The top part of the page is where I'm unsure. Where it says "County of" -- I can do that. Is there anything else to be filled out in that top area? For example, "ss.:"?