Affidavit template

STATE OF __________ )

) ss:

COUNTY OF __________)
I, John Q. Public, being of full legal age and being first duly sworn according to law, depose and state as follows:
1.I am a concerned citizen and resident of _________, State of _________, for x years. I have been a (psychiatric activisit (or however you choose to describe yourself) for x years and also a member of the ABC Chamber of Commerce, director of the ????, etc. [Something about the work you do – or honors that you have received.][State how you know John or the case] and [reasons for your concerns about his welfare if he were to stay in the hospital during the appeal, while the lawsuits in Columbus are still pending against the same hospital personnel who are “treating” him now] [If you want to not name your employer, you could still show your credentials, for example, by saying “I have professional experience doing peer support, (or whatever it is).”

2.If John Rohrer were to be released from the hospital, I would be willing to provide [one or more of the following: peer support, emotional support, phone calls, email exchanges, be his friend on Facebook, would help him with transportation to doctor’s appointments, or attorney appointments, or court appearances on occasion, would help him find work including work in peer operated services to others which I understand he is already interested in, would offer him tips on nutrition, would help him with obtaining records and paperwork from government offices, would help him with goal setting or budgeting, would help him get up to speed on the changes that have come about in computer technology since 2009] and/or whatever else you may be able to have time to do to provide support as he re-enters the world outside the hospital.


John Q. Public., Affiant

SUBSCRIBED AND SWORN to before me in my presence this _____ day of ______________, 201__.


Notary Public

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