______________________________________________________________________________
AFFIDAVIT OF BROADCAST
State of Oregon, )
) ss.
County of ______ )
I, _____, being first duly sworn, depose and say that I
am the owner, manager, assistant manager or program director of station _____, a radio (television) station broadcasting from _____ in the aforesaid county and state; that the notice (or other material) described as _____ was broadcast on the following days: (here set forth dates and times when the same was broadcast).
________
Subscribed and sworn to before me _____ (Month) ___ (Day), 2___.
________
Notary Public for Oregon
My commission expires: ______
______________________________________________________________________________ [1967 c.63 §5]