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Affidavit

Applicant(s)/Appellant(s):
Subject:
Property Address/Description:
Municipality:
Municipal File/Reference No:
OLT Case No.:
OLT File No.:
OLT Case Name:
Affidavit file on behalf of:

I, of , in the , MAKE OATH AND SAY (or AFFIRM):

(Set out the statements of fact in consecutively numbered paragraphs, with each paragraph being confined as far as possible to a particular statement of fact.)

Sworn (or Affirmed) before me at the of in the
of on , 20

(This form is to be signed in front of a lawyer, justice of the peace, notary public or commissioner for taking affidavits.)