Lost Document Affidavit

I, , of legal age, residing at , do hereby state under oath:

Affidavit

  1. That I am the owner/legal possessor of the following document:
    Document Type:
    Document Number:
    Issued by:
    Date of Issue:
  2. That the above-stated document has been lost on or about and after diligent search, it cannot be found.
  3. That I am executing this affidavit to attest to the truth of the foregoing facts and for whatever lawful purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this day of , 20 at .
Affiant's Signature over Printed Name
SUBSCRIBED AND SWORN to before me this day of , 20 at .
Notary Public