Fill and Sign the Affidavit Letter Sample Form

Affidavit by an Individual in Connection with a Forgery of the Individual = s Name to a Check. STATE OF ____________________ COUNTY OF _______________________ PERSONALLY appeared before me, the undersigned authority in and for said county and state , ________________________________, who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. The undersigned affiant is over the age of twenty-one (21) years and, on ___________________________ (month, day, year) was, and still is, a depositor in ________________________________ (name of bank) at its office at __________________ ________________________________ (street address, city, county, state). 2. On _________________________ (month, day, year) , I alone was authorized to draw checks on or endorse checks to ________________________________ (name of bank) on my account number _______________. 3. I have examined the signature on check number __________dated ___________________ (month, day, year) purported to be drawn by me on ________________________________ (name of bank) , and state that I did not write or authorize to be written this signature. 4. The signature is a forgery and was made by someone unknown to affiant. 5. The purpose of this affidavit is to induce ________________________________ (name of bank) to credit my account number _______________ in the amount of the above - described check. (Any Further Statement of Facts by Affiant) SWORN to and subscribed before me, this the ____ day of _____________, 20____. ____________________________ NOTARY PUBLIC My Commission Expires: ______________________