General Affidavit Connecticut

State of Connecticut
County of ________________


BEFORE ME, the undersigned Notary, ____________________ [name of Notary before whom affidavit is sworn], on this _________ [day of month] day of _______ [month], 20 __, personally appeared ____________________ [name of affiant], known to me to be a credible person and of lawful age, who being by me first duly sworn, on _______ [his or her] oath, deposes and says:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________
[set forth affiant's statement of facts]


__________________________________
[signature of affiant]


__________________________________
[typed name of affiant]


__________________________________
[address of affiant, line 1]

__________________________________
[address of affiant, line 2]


Subscribed and sworn to before me, this _________________ [day of month] day of _________________ [month], 20____.

  [Notary Seal:]



__________________________________
[signature of Notary]
    
           
__________________________________
[typed name of Notary]

        NOTARY PUBLIC

        My commission expires: ________________, 20____.



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