NYC 9/11 Public Portal Document
INDIVIDUAL VERIFICATION
STSTO-0©RSfiW®®RK ))
)) 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 XL., 2014
SIGN HERE; X -----
PRINT NAME HERE: 34^^
Sworn to before me this H
day of June, 2014
Q
itary Public /
AUREUC VICTOR GRILLO JR.
Notary Public, State of New York
No. 0iGR4699761
Qualified ir> Queens County
Commission Expires Nov. 30,20 i~?
10
NYC-WTC_000159528
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