Proof of publication by broadcast of the notice shall be made by affidavit of the owner, manager, assistant manager or program director of the station, in substantially the following form:
AFFIDAVIT OF BROADCAST
State of New Hampshire
County of __________
I __________ , being duly sworn, depose and say that I am the owner, manager, assistant manager or program director of station __________ , a radio (television) station broadcasting from __________ , and state that the notice (or summary or description of the notice) described as __________ was broadcast on the following days:
(here set forth dates and times when the notice was broadcast.)
_ Subscribed and sworn before me ________________, 20 ________________ ___ . Month, Day
Notary Public/Justice of the Peace
My commission expires: