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.
Subscribed and sworn to before me this ____________________ day of ____________________ 20 ____________________
My commission expires ____________________ 20 ____________________