Affidavit Of Loss

This free, printable affidavit of loss can be used by public notaries and victims of theft and fraud.

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AFFIDAVIT OF LOSS

STATE OF ____________________
COUNTY OF ____________________

I, ____________________, 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 ____________________ at ____________________.

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 ____________________ 20 ____________________

____________________
(Notary Public),

____________________ County.

My commission expires ____________________ 20 ____________________

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