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S1"p,"rE~ ~~",(:""~O'\~S

RECEIV"=D

STATE OF CONNECTICUT MAR 142012


STATE ELECTIONS ENFORCEMENT COMMISSION
20 Trinity Street Hartford, Connecticut 06106-at(EtNT CO~IM!SSON

Affidavit of Complaint mMPLANTtr.


I, Ai ~,.)3C,AiN\-~).
Print Name of

Complainant

, ,
Print Phone Number

101240

am a resident of 16 hi.m\'Ctm ~v-e ~


Print 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,

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--. ?~'.

(Use attached page(s) if

necessary)

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 Id.

at JX"-i'~cL\~A-

Signe~ ltL :k4A


Oath Administered By:

Title

Note: This oath may be administered by anyone authorized by Section 1-24 of


the Connecticut General Statutes, which includes notaries public; justices of the peace, town clerks and assistant town clerks, judges and clerks of any court, and attorneys who are Commissioners of the Superior Court of Connecticut.

D. P CONLON
NO fA R Y j' CBLlC
MYCOMMISSION EXPIi1ES MAY 31, 2014

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