Oath/Affirmation of State Employees and Public Officers New York by TomDonnelly


									                           New York State Senate or New York State Assembly
                                    Member, Officer or Employee

Name of Appointee:
                            (Last Name)                         (First Name)                                                    (Middle Initial)

STATE OF NEW YORK                                  )
                                                           Insert the name of the County within New York State in which this Oath is being
                                                   ) ss:   executed. Please note that ss: does not stand for “social security.” The appointee’s
COUNTY OF                                          )       social security number should NOT be inserted anywhere on this form.

I do solemnly swear (or affirm) 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 the office of

Title of Position:

House of the Legislature:

according to the best of my ability.

(Signature of Appointee)

Sworn (or affirmed) before me this

day of                                    , in the year, 20             .

Notary Public

                             (Do not include any social security number anywhere on this form)

DOS-1692 (Rev. 11/06)

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