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 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: June 2014
SIGN HERE: X k t
PRINT NAME HERE:
0^
T
Sworn to before me this
day of June, 2014
VINCENT R 5AVARESE
Notary Public • State of New York
NO. 01SA6283898
Qualified in Nassau County
My Commission Expires Jun 17, 2017 »
Notary Public
III
NYC-WTC_000159511
OCR can misread numbers and units. Confirm readings against the page image before using them.