Form Nyf-1 - Franchise Registration Application/form Nyf-2 Page 4

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STATE OF _____________________)
: SS.:
COUNTY OF ____________________)
Personally appeared before me this ___________ day of
____________________, 20__, the above-named _________________________
________________________________ (and) _____________________________
to me known to be the person(s) who executed the foregoing
application (as ______________________ and ____________________________
___________________ respectively, of the above-named applicant)
and (each), being first duly sworn, stated upon oath that said
application, and all exhibits submitted herewith, are true and
correct.
______________________________________
(Notary's Seal)
______________________________________
(Notary)

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