Affidavit of Lost Promissory Note

AFFIDAVIT OF LOST PROMISSORY NOTE

Before you use this: Complete only facts the affiant knows or can identify from records. Attach an available copy of the note and transfer records. Ask the recipient whether it requires its own affidavit, a bond, or other protection. Do not sign until the oath or affirmation is administered.

State of [STATE]

County of [COUNTY]

I, [AFFIANT FULL NAME], being duly sworn or affirmed, state:

1. I am [ROLE AND RELATIONSHIP TO THE NOTE]. My address is [ADDRESS]. I know the facts below because [DESCRIBE PERSONAL KNOWLEDGE AND RECORDS REVIEWED].
2. The missing promissory note is identified as follows: maker [NAME]; original payee [NAME]; date [DATE]; original principal [AMOUNT]; maturity date [DATE OR TERMS]; account or loan identifier [IDENTIFIER]; collateral, if any, [DESCRIPTION]. Its unpaid amount as of [DATE] is [AMOUNT], based on [IDENTIFY PAYMENT RECORDS].
3. The note's material terms, including payment and interest terms, are [SET OUT TERMS OR IDENTIFY ATTACHED TRUE COPY]. ☐ A true copy is attached as Exhibit A. ☐ No copy is available; the terms are established by the records identified in Exhibit [LETTER].
4. The note came into the possession of [PERSON OR ENTITY] on [DATE] by [DESCRIBE DELIVERY OR TRANSFER]. The chain of possession and any endorsements or assignments known to me is [DESCRIBE; IDENTIFY AND ATTACH RECORDS].
5. The original was last known to be in the custody of [PERSON OR DEPARTMENT] at [PLACE] on [DATE]. I learned it was missing on [DATE]. The circumstances of its loss, destruction, theft, or unknown location are [FACTS; SAY WHAT IS UNKNOWN].
6. The following search was made for the original: [LOCATIONS, RECORD SYSTEMS, PERSONS CONTACTED, DATES, AND RESULTS]. The original ☐ was destroyed ☐ cannot be located ☐ is believed to be in another person's possession because [EXPLAIN].
7. To my knowledge, the note has ☐ not been paid in full ☐ not been cancelled ☐ not been intentionally transferred away after the loss. Explain any exception or uncertainty: [DETAILS].
8. I submit this affidavit to [RECIPIENT] for [SPECIFIC PURPOSE]. I will promptly notify [RECIPIENT] if the original is found or a competing claim appears. Any protection or further proof required by applicable law or the recipient will be addressed separately.

I have read this affidavit. The statements above are true to my personal knowledge except where I expressly identify records or another source.

Affiant signature: ______________________________ Date: [DATE]

Printed name and title: [NAME AND TITLE]

Exhibits: [LIST EACH ATTACHMENT OR WRITE NONE]

Oath or affirmation

Sworn to or affirmed and subscribed before me by [AFFIANT NAME] on [DATE] at [PLACE].

Notarial officer signature: ______________________________

Printed name and title: [NAME AND TITLE]

Commission, seal, and other details required where the oath is administered: [COMPLETE OR ATTACH LOCAL JURAT]