Affidavit Of Loss

AFFIDAVIT OF LOSS

STATE OF

COUNTY OF

, having been duly sworn,

do depose and attest that I reside at

in the county of

in the state of

and that I am of legal age.

That on

, I lost

Details of the Situation:

I further attest that I have made all efforts forthwith to locate the lost item to no avail and

that I consider the item to be irretrievable.

I depose to the affidavit in good faith conscientiously believing its contents to be true and

correct according to the law.

AFFIANT

Subscribed and sworn to before me this

day of

(Notary Public),

County.

My commission expires

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Parent category: Legal