NYC 9/11 Public Portal Document
jun t-axoiTuiccxincnxer ni»»4»0»304 page n
>
INDIVIDUAI. VERIFICATION
STATE OF NE' ]
ss.:
COUNTY Oi
The undersigned, being duly sworn, deposes and says, that I am a
claimant in the within action, that I 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: Juners)^ , 2014
SIGN HERE: X.
PRINT NAME
Sworn to before me this
day q.f-slw5^,.,:^l 4
\
-------
Notary Public
^^fS*****
OMimilMim
10
NYC-WTC_000159507
OCR can misread numbers and units. Confirm readings against the page image before using them.