NYC 9/11 Public Portal Document
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INDiyiDUALVERIHCATIQN !
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STATE OF NEW YORK )
COUNTY OF j ss.:
The undersigned, being duly sworn, deposes and says, that I am a
claimant in th© 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; Jun© 4^ 2014
SIGN HERB: X. y,
PRINT NAME HERE:,
!•
.!
Sworn to before me this I!
day of June, 2014
Notary Pu
□BANNA M GROSSI
NOTARY PUBLIC.STATE OF NEW YORK
No. 01GR6070224
Quodflad In Wastohotter County
My commission Expires Moy OB, 20
10
NYC-WTC_000159517
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