Affidavit of NYO SA [Redacted]

-II BI INFOPEATION CONTAINED
HELIN IS UNCLASSIFIED
LATE 07-23-2CC9 BY 65179 DMH/YJS
SWORN STATENIEllr
or use of this form, see AR 190•4S; the proponent agency is Office of -The Deputy Chief of Staff for Personnel.
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ADDRESS F / ', N \I- '
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, , WANT TO MAKE THE FOLLOWING STATEMENT UNDER OATH:
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FB1018631ClEiT
EXHIBIT • ' • INITIALS OF P MAKING 'STATEMENT . . • . .
PAGE 1 OF • • • i '-' . PAGES
' A5DMONAL PAGES MUST CONTAIN THE HEADING 'STATEMENT OF • . .T AKEN AT ' . 'DATED CONTINUED.'
' THE BOTTOM 0F. EACH ADDITIONAL PAGE MUST BEAR THE INITIALS OF THE PERSON MAKING THE STATEMElkf F AND BE
INITIALED AS 'PAGE - OF PAGES. WHEN ADDITIONAL. PAGES ARE UTILIZED, THE BACK OP PAGE 1 WILL BE LINED OUT,
AND THE STATEMENT WILL BE CONCLUDED ON THE REVERSE SIDE OF ANOTHER COPY OFTHIS FORM. • '
FORM 282
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DOJOIG012946
FILE NUMBER: •
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STATEMENT (Continued) . . - . . . . . . . . • .
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• ' - • • • AFFIDAVIT. • •.. ..
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.. CH BEGINS
THE S • • •
STATEMENT. l' HAVE
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HAVE READ OR HAVE HAD 'WAD TO ME THIS STATEMENT
- •-,Az J. INNU t.NDS 0 PAGE/. I FUL Y UNDERSTAND 11-1E CONTENTS OF THE ENTIRE STATEMENT MADE BY ME.
- •• • 1VE INITIALED ALL CORRECTIONS AND HAVE INI•11ALED THE BOTTOM OF EACH PAG CONTAINING THE
MADE THIS S . • • n ITHOUT HOPE OF BENEF 0 RFWARO. WITHOUT THREAT OF PUNISHMENT,
AND WITHOUT-COERCION,•NLAWFUL INFLUENCE, OR UN • "u = - E EN .
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' • • . - . (Signature of Person Making Statement) • .
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WITNESSES: ,.
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. . • • Subscribed and sworn to before me,.a person authorized by '
rOc-• FQ, f ' NY ' to administer oaths, this ,.., day of I•INI • , 20 • .b
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ORGANIZATION otz ADDRESS ,
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ORGANIZATION OR ADDRESS • . •
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INITIALS OF N MAKING STATEMENT • ..
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