HomeMy WebLinkAboutLibretto, StevenOf~tl]d~f Office for ¥olmlteer Fire Policemen'
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STATE OF NEW YORK " ' .
SUFFOLK cOuNTY "
TOWN OF SOUTHOLD ~ ~ , ..
i, S'ceven T.±bz:e'ct, o' ' ' , ....... , ............ do solemnly swear {or affirm).
(Type or .~rln~ NMe)
Ihai I will support the Constilution of the Uniled Stales, and the Constitution of the .State
of. New York, and that I will faithfully discharge the duties ~l~ the office of Fhe Policeman
· 'Mat, tit, uc]c e artmenI' accordln lo the beBt of
of the ......., ............ ,,, ............ , .... , ..... . ...... , .... ,.Fire D p , ;g, .
- Signature ......................... ' ........... ~ ..... *
· . ..... ,~ ~....~.~ .... '.~.~ .......... .
. I-'OSt Olllce ,, ....... '. .... ,..., . . "
Sworn to~be~fote me, this .., .~... .... day
o, ........ .....
A ALLAN C. DICI(ER~ON
NOTARY PUBLIC, STATE ~.: ~ ?,'J ';'~ '~
OU,~',. ,:; "} I~l $~JFFOLK CO.,~O.~.~-.~i ~
Original to be filed with Town (Village) Clerk.
Copy lo be held by Department Secretory.