NYC 9/11 Public Portal Document
INDIVIDUAL VERIFICATION
STATE OF NEW YORK )'
COUNTY
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 iL. 2014 //
SIGN HERE: X.
PRINT NAME HERE;
Sworn to before me this
day of June, 2014
^NptW Public //
““7Qualified
S&S™ in Kings County ,
CowlssIon Expires
10
NYC-WTC_000159534
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