Fill and Sign the Forgery Form

AFFIDAVIT OF FORGERY STATE OF COUNTY OF ____________________ I, ____________________ (1), of the City of ____________________ (2), State of __________________(3) being duly sworn, deposes and says that a certain check No. ______ (4), dated ____________________(5) on ____________________ (6) Bank, ___________________(7) Branch in favor of _______________________ (8) in the amount of $_____________ (9) and endorsed by _______________________ (10) and purporting to be signed by _______________________ (11) and paid by _______________________(12) on the day of ____________, 20___ (13), was not signed or endorsed by me, and that this signature on said check is a forgery. I further state that I did not authorize the signing or endorsement of said check, and that no part of the money so paid by _______________________ (14 ) was received by me, directly or indirectly, and that no part of said money was applied to any use or purpose in my behalf. I further state that I will testify, declare, depose or certify to the truth of any or all of the foregoing before any competent court, officer, or person in any case now pending or that may be hereafter instituted in connection with the matter contained in this affidavit. ________________________________ Signature of Person giving Affidavit Subscribed and sworn to before me on this ___ day of _______________, 20 . _______________________________________ Notary Public My commission expires ____________________ INSTRUCTIONS 1. Name of person claiming the item is forged. 2. City of residence. 3. State of Residence. 4. Check number of forged item. 5. Date of forged item (located on face of check). 6. Name of Bank (Drawee, i.e., The party directed to pay the amount of the check) 7. Branch of Drawee Bank. 8. Payee on forged check. 9. Amount of forged check. 10. Name of forger. If unknown or illegible write A unknown. @ 11. Payee on forged check. 12. Name of Drawee Bank. (Bank will always be the bank listed on the face of the check). 13. Date check paid. (Obtain this information from the back of the check). 14. Name of Drawee Bank.