STATE OF ___________________
COUNTY OF __________________ ss.:
_______________________________, being duly sworn, deposes and says that is the _________________ in this proceeding; that has read the annexed _________________ and knows the contents thereof; that the same is true to the knowledge of deponent except as to the matters therein stated to be alleged upon information and belief, and as to those matters believes it to be true.
__________________________________
(Signature)
Subscribed and sworn to before me this
__________ day of ____________, 20 _________
______________________
(Signature and title of officer)
N.Y. Comp. Codes R. & Regs. Tit. 8 § 279.7