COMMONWEALTH OF MASSACHUSETTS

WORCESTER, ss						SUPERIOR COURT
								NO.  

__________________________________________
							)
COMMONWEALTH OF MASSACHUSETTS	)
							)	
			Plaintiff,			)
							)	
v.							)	
							)	
TERESA SMITH, SMITH /BERKLEY, LLC	) 
d/b/a SHADOW SB					)
			Defendants			)
__________________________________________)

AFFIDAVIT OF                                        

1.  My name is

2.  I  reside at

3.  I purchased a __________________ from the company _________________ via the internet.

4.  The computer equipment cost a total of ________________.

5.  Payment was made by

6.  I received confirmation of my purchase by

7.  I was informed on the following dates that I would receive a refund:

8.  I received a refund check from the defendant in the amount of ________________.

9.  I was unable to obtain the refund monies because

10.  As of this date I have not received my computer purchase or a refund of the purchase price.

	Signed under pains and penalties of perjury,

 						_____________________________

Date: