NYC 9/11 Public Portal Document
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STATE OF NEW YORK )
ss.:
COUNTY OT/9Mg^o3 )
The undersigned, being duly sworn, deposes and says, that 1 am a
claimant in the within action, that I have read the foregoing NOTICE OF CLAIM
/NOTICE OP INTENTION TO MAKE CLAIM ond 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 os to those matters, I believe them to be true.
DATED: June zv , 2014
SIGN HERE: X_
PRINT NAME HERE:
Sworn to before me
day of June, 2014
Notary Public
CHRISTOPHER WBROSKY
NMffy PuNle - Stat* el Naw York
m>. 1W82ZSM9
OutWiM M Quom* CouMir/
10
NYC-WTC_000159489
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