A sworn statement that a title, registration, license, passport, or other important document or item has been lost. Often required by the DMV, agencies, or institutions to issue a duplicate.
This is what your final document will look like. The watermark is removed after payment.
STATE OF _______________
COUNTY OF _______________
I, [Affiant Name], residing at , , , , being of legal age and being duly sworn, hereby declare under penalty of perjury that:
The item which is the subject of this affidavit is described as follows:
| Type of item: | |
|---|---|
| Identifying / serial number: | |
| Date originally issued: | |
| Issuing authority: |
The above-described item was lost on or about [Loss Date].
I have made a diligent and thorough search for the above-described item and have been unable to locate it. I have no knowledge of who, if anyone, may presently possess the item. To the best of my belief, the item has been lost, misplaced, stolen, or destroyed, and is not in my possession or under my control.
I further declare that the lost item has not been pledged, assigned, transferred, or otherwise disposed of by me.
This affidavit is provided for the following purpose:
I declare under penalty of perjury under the laws of the State of _______________ that the foregoing is true and correct to the best of my knowledge and belief.
Executed on this [Date].
AFFIANT
Signature
[Name]
Printed Name
Date:
State of _______________________, County of ______________________
Sworn to (or affirmed) and subscribed before me by means of [ ] physical presence or [ ] online notarization, this _______ day of ____________________, 20_____, by ______________________________________, who is personally known to me or who has produced ______________________________________ as identification.
Notary Public Signature
Printed Name: ______________________________________
Commission No.: _________________ Expires: _________________
[ AFFIX NOTARY SEAL HERE ]
Prepared via YYMA Documents · yymanotary.com · Self-help document preparation · Not legal advice
ESTADO DE _______________
CONDADO DE _______________
Yo, [Nombre], con residencia en , , , , siendo mayor de edad y debidamente juramentado(a), declaro bajo pena de perjurio lo siguiente:
El objeto que es materia de este affidavit se describe a continuacion:
| Tipo de objeto: | |
|---|---|
| Numero de identificacion / serie: | |
| Fecha de emision original: | |
| Autoridad emisora: |
El objeto antes descrito se perdio en o alrededor del [Fecha].
He realizado una busqueda diligente y exhaustiva del objeto antes descrito y no he podido encontrarlo. No tengo conocimiento de quien, si es que alguien, pueda poseer actualmente el objeto. A mi mejor saber y entender, el objeto se ha perdido, extraviado, robado o destruido, y no esta en mi posesion ni bajo mi control.
Ademas, declaro que el objeto perdido no ha sido pignorado, asignado, transferido o dispuesto de otra manera por mi parte.
Este affidavit se proporciona para el siguiente proposito:
Declaro bajo pena de perjurio bajo las leyes del Estado de _______________ que lo anterior es verdadero y correcto.
Ejecutado en este [Fecha].
DECLARANTE
Firma
[Nombre]
Nombre Impreso
Fecha:
Estado de _______________________, Condado de ______________________
Juramentado (o afirmado) y suscrito ante mi, en este dia _______ de ____________________, 20_____, por ______________________________________.
Firma del Notary Public
Nombre impreso: ______________________________________
No. de Comision: _________________ Vence: _________________
[ COLOCAR SELLO NOTARIAL AQUI ]
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