Sample client affidavit

• Author: Scott M. Riemer/Jennifer L. Hess
• Pages: 243-253

A-225 Appendix: Sample Documents Form 12

FORM 12 SAMPLE CLIENT AFFIDAVIT

AFFIDAVIT OF JOHN SMITH

STATE OF NEW YORK )

) ss:

COUNTY OF NEW YORK )

JOHN SMITH, being duly sworn, deposes and says:

 



PERSONAL HISTORY

 

northeastern United States.

3. Before becoming disabled, I had always led an active lifestyle. In my free

time, I participated in many rigorous outdoor activities, including snowboard-

ing, riding my motorcycle, running, hiking and mountain biking as often as

possible. I frequently worked on my house and completed repair projects for

my parents’ house and their restaurant. I also was a frequent swing dancer.

The sense of accomplishment I felt from participating in these activities was



 



GENERAL WORK BACKGROUND

      

engineer and construction inspector on projects involving airport infrastructure,

environmental remediation, and contract administration. My work typically

involved construction inspection, project scheduling and coordination, layout

and surveying, procurement, fabrication oversight, preparation of contracts and







in every sort of weather condition. The work was challenging, but I enjoyed

it tremendously and looked forward to moving up in my career.