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Lost Warehouse Sale

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					                                  Iowa Department of Agriculture and Land Stewardship
                                               Grain Warehouse Bureau
                                     LOST WAREHOUSE RECEIPT RELEASE
  [THIS FORM IS TO BE USED FOR LOST WAREHOUSE RECEIPTS ONLY IN INSTANCES WHERE THE GRAIN HAS BEEN
  PURCHASED BY THE WAREHOUSE OPERATOR OR IS BEING REMOVED FROM STORAGE BY THE RECEIPT HOLDER]

WAREHOUSE RECEIPT NUMBER___________________ UNDER WAREHOUSE LICENSE NUMBER W-________________

The undersigned, being the lawful holder of the above designated warehouse receipt, hereby surrenders all claims to the commodities
represented by such warehouse receipt.

The undersigned further represents that the said warehouse receipt is lost or has been destroyed and cannot be produced for
cancellation, and hereby acknowledges delivery of or payment for the products represented it by the warehouse operator issuing it; and
further that, should such receipt be presented by any other person as a claim for the products it represents, such claim would be
resisted as a fraud by the undersigned and full indemnity is guaranteed to the warehouse operator because of such claims. If the
above-numbered warehouse receipt is found, it will immediately be tendered to the warehouse operator for cancellation.

This _______________ day of _________________________________, ______________.

                                                                       ________________________________________________
                                                                                signature of warehouse receipt holder
State of _____________________ )
                                   )
County of ___________________ )

Subscribed and sworn to before me, a Notary Public in and for the state and county above named, this _____________ day of

_________________________________, ______________.
                                                                       _______________________________________________
                                                                                         signature of notary public
THIS FORM MUST BE PREPARED IN DUPLICATE                                                                                      009-0628

				
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posted:8/11/2009
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