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 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\
PRINT NAME HERE:,
Sworn to before me this
day of June, 2014
Xotary P^lic
HAZEL 2ARI0
Notary Public, State of New York
No. 24-4986738
Qualified in Queens County
Commission Expires 9/23/20|'^
10
NYC-WTC_000159542
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