NYC 9/11 Public Portal Document
INDtVIDUAl VERIFICATION
STATE OF NEW YORK )
) ss.:
COUNTY OF - . - )
The undersigned, being duly sworn, deposes and says, that I am a
claimant in the within action, that I have read the foregoing MPH^ OF_CLA1W
/NOTICE OP INTENTION TO MAKE CLAIM and know the contents thereof; that the
same is true to my own knowledge, except as to the matters therein alleged to
be on information and belief, and as to those matters, I believe them to be true,
DATED: June.__ ,2014
SIGN HERE: X_ /^4zU.
PRINT NAME HERE: !r
/y^zL^
Sworn to b^re me this
day of 2014
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Notary Public » s I OU«p*'lMDtN t s
« I QUECfis COUNTY I «
10
NYC-WTC_000159486
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