Affidavit Lost Stock

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					                       AFFIDAVIT OF LOST STOCK CERTIFICATE

STATE OF: __________)
                    ) SS
COUNTY OF :________)

_________________, [Insert Name] (the “Holder”), of __________________________
[Insert Address] being duly sworn, does hereby swear and affirm as follows:

    1) The Holder is of legal age and is the sole legal and beneficial owner of
       _______________ [Number] shares of _____ [class] stock, ________ par value,
       of ______________, a ______ [corporation][limited liability company][etc.] (the
       “Company”), represented by Certificate Number[s]
       _________________________  (the “Original Certificate[s]”), issued on
       __________ [date] by the Company in the name of the Holder.

    2) The Original Certificate[s] has/have been [lost] [stolen] [destroyed].

    3) The Original Certificate[s] was/were [not endorsed] [endorsed as follows:

    4) None of the Original Certificate[s], or any of the Holder’s rights therein, have, in
       whole or in part, been assigned, transferred, hypothecated, pledged, gifted, or
       otherwise disposed of in any manner whatsoever.

    5) The Holder is entitled to the full and exclusive possession of the Original
       Certificate[s], and no other person or entity has any right, title, claim, equity, or
       interest in, to, or respecting the Original Certificate[s] or the proceeds thereof.

    6) The Holder has made the following efforts to locate the Original Certificate[s]
       [The destruction of the Original Certificate[s] occurred as follows]: 
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Description: No matter the system, physical certificates are often misplaced or destroyed accidentally. In such cases, the stockholder will need to replace the documents, a process that starts with the completion of an affidavit of lost stock certificate. This package contains everything you’ll need to customize and complete your affidavit. Companies usually require stockholders who have lost or destroyed certificates to provide this document before they will issue replacements. If you follow the enclosed sample and guidelines, you can resolve the situation quickly, and may prevent the investment loss you could face if someone obtained your document before you had the chance to report it missing.
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