Affidavit Of Lost Note

AFFIDAVIT OF LOST NOTE

STATE OF

COUNTY OF

, residing at

in the county of

in the state of

having been duly sworn, do hereby depose and attest:

1. I am the sole owner of the lost promissory note or other indebtedness, executed by

, on behalf of the Trustee,

, in the amount of

and date as of

. OR that I am the authorized officer, agent,

or representative of the company that is the sole owner of the note.

2. The note has been lost, misplaced, damaged or destroyed and cannot be

produced, located or recovered after the exercise of due diligence.

3. The amount still owed to the holder is

, OR

The amount has been paid in full as of

The note has not been transferred or sold to a third party.

4. This affidavit is made knowing that the Borrower,

will rely on the truth and validity of the statements made in this document.

Signature

day of

Subscribed and sworn to before me this

(Notary Public),

County.

My commission expires

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