HAND-DELIVERY COVERSHEET / PROOF OF SERVICE (MAILROOM STAMP)
CONNECTICUT GENERAL ASSEMBLY — HAND DELIVERY
TO (Office / Member / Committee): ____________________________________________
ATTN: ☐ Member ☐ Chief of Staff ☐ Committee Clerk ☐ Mailroom Personnel
FROM: ____________________________________________ (Affiant / Delivering Party)
PHONE / EMAIL: ____________________________________________
DATE OF DELIVERY: ____ / ____ / 2026 TIME: __________ ☐ AM ☐ PM
DELIVERED BY (Name): ____________________________________________
DOCUMENT(S) ENCLOSED (CHECK ALL THAT APPLY)
☐ Affidavit of Fact, Constitutional Objection, and Petition for Redress
Re: SB 6 — Section 5
Affiant: ____________________________________________
Date executed: ____ / ____ / 2026
Pages: _______ Copies enclosed: _______
☐ Written Testimony Re: SB 6 (Section 5) — Pages: _______
☐ Exhibits/Attachments (list): _________________________________________________
PURPOSE
Hand-delivered for placement into the legislative/public record and for notice to the above recipient(s) regarding SB 6, Section 5.
RECEIPT ACKNOWLEDGMENT
(PLEASE STAMP AND RETURN THIS PAGE)
I acknowledge receipt of the above document(s) delivered to the Connecticut General Assembly.
RECEIVED BY (Print Name): ____________________________________________
TITLE / OFFICE: ____________________________________________
SIGNATURE / INITIALS: ____________________________________________
DATE STAMP / RECEIVED DATE: ____ / ____ / 2026 TIME: __________ ☐ AM ☐ PM
OFFICIAL STAMP (if available): _________________________________
Optional: one-line instruction at the bottom (helps in the moment)
Instruction: Please stamp or initial/date this coversheet and return it to the deliverer as proof of receipt.
RECIPIENTS SERVED (MAILROOM/OFFICE CHECKLIST)
Please check and initial each intended recipient/office that this delivery is being logged for:
| ☐ | Recipient / Office | Initials | Date/Time |
| ☐ | Committee on Children — (if available)Committee Clerk | ______ | //2026 : ☐AM ☐PM |
| ☐ | Sen. Ceci Maher (Co-Chair) | ______ | //2026 : ☐AM ☐PM |
| ☐ | Rep. Corey P. Paris (Co-Chair) | ______ | //2026 : ☐AM ☐PM |
| ☐ | Sen. Jason Perillo (Ranking Member) | ______ | //2026 : ☐AM ☐PM |
| ☐ | Rep. Anne Dauphinais (Ranking Member) | ______ | //2026 : ☐AM ☐PM |
| ☐ | Sen. (fill in your senator’s name | ______ | //2026 : ☐AM ☐PM |
| ☐ | Rep. (fill in your local rep’s name) | ______ | //2026 : ☐AM ☐PM |
| ☐ | Other: ________________________________ | ______ | //2026 : ☐AM ☐PM |
| ☐ | Other: ________________________________ | ______ | //2026 : ☐AM ☐PM |
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Mailroom/Office Notes (optional): _______________________________________________