~~It V~e' - . 0, , - Jersey City

, BI;DER IDENTIFCATION
NO.
FORM B- AFFIDAVIT OF EMERGING SMALL BUSINESS ENTERPRISE (ESBE) STATUS
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. :iC.ÖUN1'YOF' 10'Y · ,
OFW-Il,'tL .INmE'COUNTY'OF
, BEING FULL AGE AND SWORN ACCORDING TO LAW ON
. . Pwl ~. Selo OFTIl_~'''.
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t:lt\ ..,., COO OFTHFIRMOF::LJLfJ. J't.ii.c.", .Ic '.
:;;u.(~a ,'. .. AND THE STATE OF
':;MY;ÖA~ '.,.. 'DEPOSE AN SAY THAT:
.HAvr~GANADDRESS OF 90 i.. ~1C/i" Sf. rf'ÜJi(c- /VJ D"7IøC/
FiRM
niCH
is A DEFID INSECllON V, PARGRAH B~
. .
lFURTHER WARRNT THAT I AM AUTHORIZED BY THE SAID FIRM TO MA THIS AFFIDAVIT AND WILL PROVIDE
INFORMTION REQUESTED BY THE NEW JERSEY DEPARTMENT OF TRANSPORTATION TO DOCUMENT THE FACT
..d. 'lT'l SAl .FJS AS lla IN SECTION V, l'ARGRAH B. æ~
(SIGNATUR)
...Sti~~::S~TO -:¡r ME TI
.......'. .' NOTARY PUBLIC o~
iVCO:MSSION EXPIRES' L.. 2Ø/7'.
,.- OIANE MArM~O . 1.1)
Commission # 2382124 d ,
Notary Public, State of New Jeruy
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):iEPERA ATTACHMNT .
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