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BATH dF OFFICE FORM NO. 69 w~inamsar~ haw gook ca., victor. Nv inssn
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I, ~i~7.~r~~Q..,,~ ~~-~~..~-~-~~2~. , do solemnly swear that
I wit! support the Constitution of the United States and the Constitution of the State of New York,
,
and that I will fa/ifthfu/l~ly /dJischpar~g/e the duties~//}of ; ~rlL[.~2~ iii G[,~~~
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according to the best of my ability.
(Signed)
Officer
Subscribed and sworn to be#ore me this
~ ~ day of ~ 20 y 7
(Signed) ~7 ~~r~_~.~Lc~c~/
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