NYC 9/11 Public Portal Document
iNDIVIDUAL 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 NOI|CE OF CLA1M
/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: Junez^^2014
SIGN HERE; X.
PRINT NAME HERE: f
Sworn to before me this
day of June, 2014
rtTi „ia
POLLY AJODHA
Notary Public - State of New York
Notary Pdolic NO. 01AJ8281689
10
NYC-WTC_000159533
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