Affidavit of Lost Document Template

This Affidavit of Lost Document (the “Affidavit”) is made on [Date] by:

Affiant: [Full Name or Business Legal Name], address: [Address], phone/email: [Contact].
Role (Optional): ☐ Owner ☐ Party to document ☐ Authorized representative ☐ Other: [Explain]

1. Document Information

1.1 Document Type/Title: [Title]
1.2 Date Issued/Executed: [Date]
1.3 Parties/Issuer (If Any): [Names]
1.4 Reference/Serial/Account No. (If Any): [__]
1.5 Document Purpose (Optional): [What it relates to].

2. Loss Details

2.1 Last Known Location: [Where it was last seen].
2.2 Date Last Seen (Approx.): [Date]
2.3 How It Was Lost (If Known): [Brief explanation].
2.4 Search Efforts: I have made a reasonable search for the original document, including: [List steps].
2.5 Theft Suspicion: ☐ Not suspected ☐ Suspected (details): [Explain].
2.6 Police Report (If Any): ☐ Not filed ☐ Filed (agency: [], report no.: [], date: [__]).

3. Replacement / Reissue Request

3.1 I request: ☐ a replacement original ☐ a certified copy ☐ reissuance/retitling ☐ record update ☐ other: [Request].
3.2 Any known fees or procedures: [If known].

4. Indemnity (Optional)

4.1 If required by the recipient, I agree to indemnify and hold the recipient harmless from losses arising from reliance on this Affidavit, except as prohibited by law.

5. Attachments (Optional)

5.1 ☐ Copy/photo/scan of the document (if available)
5.2 ☐ Correspondence referencing the document
5.3 ☐ Proof of identity/authority
5.4 ☐ Police report (if filed)
5.5 ☐ Other: [List]

6. Statement Under Oath

6.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.

Signatures

Affiant: [Full Name/Business Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (If Required)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Affiant Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________