Lin, Moning
OATH OF OFFICE
STATE OF NEW YORK }
COUNTY OF DUTCHESS ss,:
TOWN OF WAPPINGER
I, J!\C[ILl..J\l6..__f:lI:~J._________________, do solemnly swear that I will support the
Constitution of the United States and the Constitution of the State of New York, and that I will
faithfully discharge the duties of .fl~J~-P.o-'d.<;['~:._-:_Q~~L~t't-Lfj_iSli...__ according to the best of
b'l' l)1~t6<tCr ~
my a 1 ny, ,
Subscribed and sworn to before me this
-__6~'m day 'f7tl-'L'=~=;;,m- ,;-9)J&1
(Signed) ------~-C.:- _________ _____
-----------------~~JL__~~_~__________________
Title
New York Sate Division of Crimin8~ Justice Services
PEACE OFFICER REGISTRY ENTRY FORM. CERTIFICATION OF INITIAL EMPLOYMENT
(Executive I.sw S 84r...a)
PR I ( 5
I am the p8mon named above. I understand thet the Infonnetlon /rJ Section lis part of II written statemenl/hat will be presented to the Division of Criminal Justice Services for
filing. and I certify Ihat /I is true to the best of my knowledgfl and f.
Signature ..
Title of Person Signing Section II
Q,O;-1 r"Il SJ I D....v E /L
Tel';P,hone
;)'1 S --l-3! .,..-i:,;z, '-I L/
City. State. ZIP
C f/~L..s~A ,;J~tJ yolO( j;:{S-J,t-O/~ 8'
Wea~~;'1or (Circle All That Apply)
~ FIREARMS ASR BATON
Type at APPointme~-'--, Background Check Cond.~C!~ Reslderl~d Fingerprints SUbmitte~S
Full-time ~ Yes ~ ~ No Yes ~
I am the chief law fmfon;81Tlent offIoer responsible for appointing the person named In Section I as 8 peace office' of the above named law enforcement agency. I understBnd
l'hat the infonnatlon In Section If is part of a written staff/ment thaI will b8 presented to the Division of Criminal Justice Servlcf/8 for filing, ana I cf/rtlly tllBt It Is true to the best of
my knowledge and be/iflt I understand lam responsible for providing the reglstrent with the requisite treining pursuant to CPL ~2.30.
Slgnatu
~ f9RIf..- f/ c t--IC &-
~ C'141.rl .
Name of Civil Service or Personnel Agency
Telephone
Address
City, State. ZIP
TrUe and Civil Service Classification of the Registrant
J am the cMIBeN/ca. offICer respo!lSlb/e for certifying the appointment of IndMduals appetJring on the payroll of the ItJw enforcement agency named In Section II. I understand
that the Infonnatlon In Se~Jon fillS part of a wl'1tten statement that will be presented to the Division of Criminal Justice SeNlces for filing, and I certify that It Is true to the best
01 m knowled and b811f1f.
Signature Oal1:l
onsible for recordln oaths of office
TItle of Person Signing Section IV
CL6(ZK..
- 5T?r I
11sw
Address
N6eIL
City, State, ZIP
J.o .~
N ) JSf? (>
I am the offic8r responsible for recording lhEl oaths of office of in Mduals appointed as peace officers of the law enfofO$ment ager; named In Section /I. The person named
In Section i hss filed sn oath of office ss s pesce officer. pursuant to an appointment received from the person named in Section /I. I understand that the Wonnet/on In
Section IV is part of a written statement that will be presented 10 the DIvision pf Criminal Justice 8eNlOflS for filing, and I certitj that it Is true fo Iht: best of my k(Jowledge and
belief.
Signature
lo.JCto
w l\f {?J('l~ c:
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