Affidavit for Lost Stolen Destroyed Stock Certificate

Affidavit for Lost Stolen Destroyed Stock Certificate. Reportedly, there are more than 50 million paper stock certificates in circulation. But for me circulation means that they're tucked away in cardboard boxes under my bed, pushed to the back of a closet, or stored in the garage.

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 anyother way disposed of either the stock certificates or myrights as a stockholder, in whole or in part.

That I am entitled to full and exclusive possession of saidcertificates.

That the circumstances surrounding the [loss, or theft,or destruction, or disappearance] of said certificatesand 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 thosethat have been [lost, stolen, destroyed].

I hereby agree to surrender to [corporation] theoriginal certificates issued to me should they hereaftercome into my possession or control.

Dated:_____________________ ____________________ (Signature] [Jurat]