Trs Nyc Release Of Claim Form Page 2

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CONTINUED FROM PAGE 1
PART C: TO BE COMPLETED BY A NOTARY (NOTE: Attestation made outside the U.S. must be executed before an American consul.)
State of ____________________________ )
) s.s.:
County of __________________________ )
On the _____________ day of _________________, __________, before me personally appeared the person known to me
to be __________________________________________________________, the individual who executed the foregoing
instrument and acknowledged to me that (s)he executed the same.
Signature: _____________________________________________________
Official Title: ____________________________________________________
Expiration Date of Commission: ____________________________________
PAGE 2
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