NYC 9/11 Public Portal Document
Jut tn .uaayHTI, ZNl StHVIChS 17185766873 page 1
INDIVIDUAL VERIFICATION
STATE OF NEW YORK )
ss.:
COUNTY OP )
The undersigned, being duly sworn, deposes and says, that I am a
claimant in the within action, that 1 have read the foregoing NOTICE OF CLAIM
/NOTICE OF 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: .l_.2O14
SIGN HERE: X,
PRINT NAME HERE:
Sworn to before me this Z
day of Jtme, 2014
Z7
Norary Public
Qualified In Kinos County ;
Commission Expires Oct 15. ^0--^ J?
NYC-WTC_000159499
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