OLT Case No:
I, of the am a , MAKE OATH AND SAY (or AFFIRM AND SAY) THAT:Notice of [written] hearing of this matter, starting on and ending on at was given by:
Check the correct one(s) and fill in necessary info.
1. Publication in the on .
A copy of the published notice is enclosed as Attachment # .
2. Delivering notice by prepaid registered mail, prepaid courier, email or fax on to .
The list of persons to whom such notice was given and is enclosed to this Affidavit as Attachment # .
3. Posting copies of notice in public places in and around the municipality on to .
See the form attached for the names of the places where the notice was posted as Attachment # .
4. Any other means of service, including personal service, as may have been directed by the OLT. Service of notice of
the hearing in this matter is in accordance with the instructions given by the OLT in its letter dated, .
Please ensure that notice has been given to: present parties, any appellant, objector and/or person who requested, in writing, that he/she receive notice (as well as any persons within an area defined by the OLT in its instructions for service as being entitled to notice).
Fill out below if you are the person swearing to this affidavit.
I, in good faith and in support of have sworn to this affidavit.
Sworn before me in the on .
(This form is to be signed in front of a lawyer, justice of the peace, notary public or commissioner for taking affidavits.)