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Fill and Sign the Uniform Request and Cancellation Affidavit Lafayette Parish

Fill and Sign the Uniform Request and Cancellation Affidavit Lafayette Parish

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Affidavit of Loss of Written Instrument State of __________________ (name of state)County of __________________ (name of county)_______________________ (Name of Affiant), hereinafter called Affiant, being first duly sworn, deposes and states:1. Affiant resides at ________________________________________________________ (address of Affiant).2. Affiant is, and has been since ___________________ (first date of ownership), the lawful owner of the following instrument: ____________________________________________ ______________________________________________________ (description of instrument) .3. The described instrument was lost on or about ___________________ (date of loss), under the following circumstances: ________________________________________________ ____________________________________________________________________________ ___________________________________________________ (description of circumstances) .4. Affiant has made due and diligent search for the instrument but has not found the instrument.5. Affiant has not transferred or in any other way been divested of the ownership of, or rights under, the described instrument, except for the mentioned loss. ___________________________________Printed Name and Signature of Affiant SWORN to and subscribed before me, this the ______ day of ______________, 20______.__________________________NOTARY PUBLICMy Commission Expires:_________________________

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