Affidavit for Lost, Stolen, Destroyed Stock Certificate

AFFIDAVIT FOR LOST, STOLEN, DESTROYED STOCK CERTIFICATE

State of ______________________
County of _____________________

I, [name] , being duly sworn, state:

That I reside at [address] , [city] , [state]

That I am the legal and beneficial owner of [number]
shares of the [specify class] stock of [corporation]
represented by certificates described as follows:

Number Date Registered Name
That said certificates [were or were not] endorsed.

That I have not assigned, hypothecated, pledged, or in any
other way disposed of either the stock certificates or my
rights as a stockholder, in whole or in part.

That I am entitled to full and exclusive possession of said
certificates.

That the circumstances surrounding the [loss, or theft,
or destruction, or disappearance] of said certificates
and my attempt to locate them are as follows:
That the purpose of preparing this affidavit is to induce
[corporation] to issue new certificates to replace those
that have been [lost, stolen, destroyed].

I hereby agree to surrender to [corporation] the
original certificates issued to me should they hereafter
come into my possession or control.

Dated:_____________________
____________________
[Signature]
[Jurat]

 

About author

SMB Reviews
SMB Reviews 496 posts

SMBReviews is committed to providing small and mid-sized business owners with the information and resources they need to select the best service or product for their company.

You might also like

Business Forms

Agreement to Extend Debt Payment

AGREEMENT TO EXTEND DEBT PAYMENT   FOR VALUE RECEIVED, the undersigned, _ [Creditor] and _ [Company], hereby acknowledge and agree that: 1. The Company presently owes the Creditor the sum of

Business Forms

Shipping Delays

Dear Thank you for your order. At this time we cannot fill your order due to an unexpected shipment delay from our overseas suppliers. We will hold your order for

Business Forms

New Client

Dear Thank you for opening an account with our company. As one of the leaders in this industry, we can assure you that our products and our services will not

0 Comments

No Comments Yet!

You can be first to comment this post!