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Form 4-11 v VERIFICATION STATE OF NEW YORK ) : ss.: COUNTY OF ) being duly sworn, says that (s)he is the Petitioner in the above-entitled proceeding and that the foregoing petition is true to (h\ is)(her) own knowledge, except as to matters herein stated to be alleged on information and belief and as to those matters (s)he believes it to be true. ________________________ Petitioner Print or Type Name Sworn to before me this day of , 20 . _______________________________ (Deputy) Clerk of the Court Notary Public Form 4-11 v VERIFICATION IN PROCEEDING BY GOVERNMENTAL AGENCY STATE OF NEW YORK ) :ss.: COUNTY OF ) being duly sworn, deposes \ and says: That (s)he is \ and is acquainted with the facts and circumstances of the above-entitled proceeding; that (s)he has read the foregoing petition and knows the contents thereof; that the same is true to (his)(her) own knowledge except as to those matters therein stated to be alleged upon information and belief, and that as to those matters (s)he believes it to be true. Petitioner Print or Type Name Sworn to before me this day of , 20 . (Deputy) Clerk of the Court Notary Public