91-B:4 Affidavit.
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.)