STATE OF CONNECTICUT MAR 142012
STATE ELECTIONS ENFORCEMENT COMMISSION
20 Trinity Street Hartford, Connecticut 06106-at(E¡¡¡tNT COî~IM!SS¡ON
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Print Name of
Affidavit of Complaint mMPLANTtr.
am a resident of 16ß hi.m\'Ctm ~v-e ~
rint Complainant's Street Address
Town/Cityof k.\r2 WClvtV\
Print Town or City Name
, State of C~-r 06 ~ 15
Print State & Zip Code
and my Telephone Number is 1.~- S~'~-5.sL/'1,
Print Phone Number
I hereby allege and assert that
the election laws of the State of Connecticut have been violated in the following manner,
place and time, as specified below:
See: 0€--. ?~'è.
(Use attached page(s) if
I SOLEMNL Y SWEAR (OR AFFIRM) THAT THE ABOVE STATEMENT IS TRUE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
Dated this-=ay of~ /cL- , 20
Signe~ ltL :k4A
Oath Administered By:
Note: This oath may be administered by anyone authorized by Section 1-24 of
the Connecticut General Statutes, which includes notaries public; justices of thepeace, town clerks and assistant town clerks, judges and clerks of any court, andattorneys who are Commissioners of the Superior Court of Connecticut.
D. P CONLON
NO fA R Y j' CBLlC
MYCOMMISSION EXPIi1ES MAY 31, 2014