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Oath ~Office for Volunteer Fire emen
(New York State Municipal Law, Section 209-C,.)
STATE OF NEW YORK
SUFFOLK COUNTY N? 80
TOWN OF SOUTHOLD
I, . .... 1~1...~:..~1 .1~0~.. .............................. , do solemnly swear (or affirm)
(Type orX~rint Nmne)
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 the office of Fire Policeman
of the ...... ~.~..~..~..~.. ............. Fire Department, according to the best of
my ability.
Sworn to before me, this ./~..(... day
Notary ~~"
Post Office ~..~~~.~..Z.~..~...?
Original to be filed with Town (Village) Clerk.
Copy to be held by Department .Secretary.
Date filed ...../...~......~/...~......R!.C!!.V.ED
~J~."J ,~ i980
Town ~.¥,rk gouthold