Fill and Sign the Affidavit in Lieu of Lost Passport 497331089 Form

IN THE _____________ COURT OF _______________ (County) , ______________ (State) _______________________ PLAINTIFF (Name of Plaintiff) V. CAUSE NO. ______,______ _______________________ DEFENDANT (Name of Defendant) State of __________________________ County of ________________________ _____________________ (Name of Affiant) , being first duly sworn, deposes and says that: 1. Affiant resides at ________________________________________ (address) , __________________ (city) , __________________ County, ________________ (state) . 2. Affiant is the claimant named in the attached claim for $____________ against _______________________ (name of defendant) . 3. Affiant held a passport issued by __________________ (nation) on ______________ (date) , prior to Affiant's departure for the United States. 4. Affiant lost this passport on or about _______________ (date) , while a passenger on ______________________________ (name of train, airline, or bus line) traveling between _____________________ (name of location) and ______________________ (name of location) . 5. In lieu of the passport, Affiant submits the following information relative to Affiant 's last and only entry into the United States: A. Date of entry: ________________________ B. Port of entry: ____________________________________________________ C. Name of ___________________ (airline or ship) on which Affiant arrived: ____________________________________________ 6. Affiant has resided continuously in the United States ever since Affiant 's entry on _________________ (date) . 7. This Affidavit is made to induce _______________________ (name of defendant) bank to recognize Affiant 's attached claim. 8. ________________________________ (Signature of Affiant) ________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ______ day of ______________, 20____. __________________________ NOTARY PUBLIC My Commission Expires: _________________