GENERAL AFFIDAVIT

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:

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[set forth affiant's statement of facts]


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[signature of affiant]


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[typed name of affiant]


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[address of affiant, line 1]

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[address of affiant, line 2]


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

  [Notary Seal:]



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[signature of Notary]
    
           
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[typed name of Notary]

        NOTARY PUBLIC

        My commission expires: ________________, 20____.