I, ________ (give full name), do solemnly swear (or affirm) that I will support the Constitution of the United States, and the Constitution of the State of New York, and that I will faithfully and fairly do such acts and make such determinations and reports as may be required by the designation as a judicial hearing officer, according to the best of my ability.
_____________
(Signature)
Sworn to before me this day of, 19.
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Notary Public
N.Y. Comp. Codes R. & Regs. Tit. 22 § 122.4