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HomeMy WebLinkAboutFinnican, Michael OATH OF OFFICE FOR FIRE POLICE RECEIVED STATE OF NEW YORK OCT 2 3 2019 COUNTY OF SUFFOLK Southold T®wn Clerk DO SOLEMNLY SWEAR THAT I WILL SUPPORT THE CONSTITUTION OF THE UNITED STATES, AND THE CONSTITUTION OF THE STATE OF NEW YORK,AND THAT I WILL FAITHFULLY DISCHARGE THE DUTIES OF FIRE POLICEMAN OF THE FIRE DEPARTMENT/COMPANY, ACCORDING TO THE BEST OF MY ITY. SIGNATURE ADDRESS CITY/STATE/ZIP SUBSCRIBED AND SWORN BEFORE ME THIS "2 f'v DAY OF— Dc i a-6m 20 =7 LAWRENCE MICHAEL 7ACARESE A RY PUBLIC Notary Public,stare of New York No.02ZA6339303 Qualified in Suffolk County Commission Expires March 26,20 RECEIVE® New York State Division of Criminal Justice Services PEACE OFFICER REGISTRY ENTRY FORM-CERTIFICATION OF INITIAL EMPLOYME��T 2 3 2019 (Executive Law§845-a) SECTION i—REGISTRANT INFORMATION To be completed by the re Istrant Southold Town Clerk Last N e First Name MI Date f BirthOpewSocial Security Number Home Residence Mailing Address city,State,Zip, County of Home Residence e� 19V /!deed^ A&q (.�,W.1'e' FLIP ,�rr S'f/�� Home Residence Street Address(if Different) City,State,Zip City,State,Country of birth(if other than U S) /am the person named above. I understand that the information in Section I is part of a written statement that will be presented to the Division of Criminal Justice Services for riling,and I certify that it is true to the best of y knowledge and belief Sig ature Date S E C T 10 N 11— INFORMATION To be completed by the chief law enforcement officer Last Nage First Name MI Title of Person Signing ction II l�n�cle A Name of Law Enforcement Agency Telephone C��' t2e 631-`M3 Asa Address City,State,ZIP 260 lu ew S t-Ac'[v C' CLOj" y («3� CPL§2 10 Subdivision CPL TIUe/Position of Registrant Weapon icator(Circle All That Apply) NONE FIREARMS ASR BATON Type of Appointment Background Check Conducted Residency Verified Fingerprints submitted to DCJS Full-time Part-time Yes No Yes No Yes No I am the chief law enforcement officer responsible for appointing the person named in Section I as a peace officer of the above named law enforcement agency I understand that the information in Section Il is part of a written statement that will be presented to the Division of Criminal Justice Services for filing,and i certify that it is true to the best of my knowledge and bell _1understand I am pons a for prove g the registrant with the requisite training pursuant to CPL§2.30. Signature Date SECTION I I I—CIVIL SERVICE INFORMATION o be completed by the civil service officer for munici al and state registrants) me First Name MI Title of Person Signing Section III Name of Civil Service or Pers ency Telephone Address City,State, Title and Civil Service Classification of the Registrant /am the civil service officer responsible for cpdg the appointment of individuals appearing on the payroll of thelawnent agency named in Section ll. I understand that the information in Section 1l1 is a written statement that will be presented to the Division of Criminal Justice Services for rid I certify that it is true to the best of my knowledge and belie r gnature Date S E C T 10 N I V—OATH OF OFFICE Public Officers Only-To be completed by the registrar responsible for recording oaths of office Last Name First Name MI Title of Person Signing Section IV ! Name of RecordingOffice Telephone _av 16 Address p r City State,ZIP 2--� I am the officer responsible for recording the oaths of office of individuals appointed as peace officers of the law enforcement agency named in Section 11 The person named in Section l has filed an oath of office as a peace officer,pursuant to an appointment received from the person named in Section 11 1 understand that the information in Section IV is part of a written statement that will be presented to the Division of Criminal Justice Services for filing,and 1 certify that it is true to the best of my knowledge and 5ehef �Ignat '� Date Oath A ministered COPYRIGHT©2007 NEW YORK STATE DIVISION OF CRIMINAL JUSTICE SERVICES(JAN 2007) »31t6o