Fillable Affidavit And Indemnity Bond printable pdf download

Affidavit And Indemnity Bond

Download a blank fillable Affidavit And Indemnity Bond in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Affidavit And Indemnity Bond with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

BANKOPS-1-INDIVIDUAL

AFFIDAVIT AND INDEMNITY BOND

__________________________________________, being first duly sworn, deposes and says that

(Affiant)

warrant(s) numbered ____________________ for $_______________________ dollars, dated ________________,

allegedly issued by __________________________________________, an agency of the State of North Carolina

and drawn on the State Treasurer, and allegedly made payable to the order of this affiant,

___________ has/have not been received by me,

___________ has/have been received by me, was endorsed by me, but has/have since been destroyed,

stolen, or lost,

___________ has/have been received by me, was not endorsed by me, and has/have since been destroyed,

stolen, or lost,

___________ has/have been examined by me and the first endorsement is not my handwriting, and I have

not at any time authorized anyone to endorse the check on my behalf;

that I did not cash the warrant(s) and have never benefited in any manner from said warrant(s); that I seek to have

the State of North Carolina replace said warrant(s) and,

In consideration of the issuance of the replacement warrant(s) by the State of North Carolina, I, the

undersigned, am held and firmly bound unto the State of North Carolina in the sum of ________________ dollars

(an amount equal to the sum of the warrant(s) involved herein), to be paid to the State of North Carolina, to the

payment whereof, well and truly to be made, I bind myself and each of my heirs, executors and administrators,

firmly by these presents, so that I, my heirs, executors or administrators, shall at all times save harmless and keep

indemnified the State of North Carolina against any claim, demand, loss or expense of any character, and against all

loss and damages whatever that shall or may result at any time to the State of North Carolina, or any agency thereof,

arising out of and by reason of the issuance to the undersigned of the duplicate warrant(s) in replacement of the

warrant(s) hereinabove described.

WITNESS my hand and seal, this the _____________ day of __________________, ______

___________________________________

____________________________________(SEAL)

Last 4 digits of Social Security Number

Signature of Affiant

STATE OF _________________________________ )

COUNTY OF _______________________________ )

Subscribed and sworn to before me

This the __________ day of ______________________, ______.

____________________________________

Notary Public

My commission expires: ________________________

The statute of limitation for endorsement forgeries is three years. (G.S. 25-4-111)

Affidavit And Indemnity Bond

Related Articles

Related forms

Related Categories