Modena, PA · Chester County
General Affidavit
Property owners submit this affidavit with permit applications to state that the requested permits cover damage caused by Hurricane Ida.
What this form is
This affidavit states that permit applications for a listed property concern only damage caused by Hurricane Ida, which the form says arrived on September 1, 2021. It asks for the property address, the signer’s signature, printed name, mailing address, and date. The form warns that pre-existing damage may make the signer liable for the full cost of submitted permits and may result in penalties.
Who needs it
A person submitting permit applications to the Borough of Modena for property damage they state was caused by Hurricane Ida needs this affidavit.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer swears to the statement and signs and dates the form.
How to submit this form
- 1
Download The Affidavit
Download the General Affidavit PDF.
- 2
Complete The Form
Enter the property address, then provide the date, signature, printed name, and mailing address.
- 3
Review The Statement
Confirm that the permit applications concern only damage you state was caused by Hurricane Ida.
- 4
Submit To The Borough
Submit the completed affidavit to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Modena General Affidavit state?
- It states that permit applications for the listed property are only for damage caused by Hurricane Ida, which the form says arrived September 1, 2021.
- Who should complete this affidavit?
- A person submitting permit applications for property damage they state was caused by Hurricane Ida should complete the affidavit.
- Do I need a notary for the Modena General Affidavit?
- No. The document has no notary block; the signer swears to the statement and signs and dates the form.
- How do I submit the Modena General Affidavit?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This General Affidavit doesn’t need a notary — but if you have another Modena form that does, a commissioned online notary can help.