Affidavit for Lost, Stolen, Destroyed Stock Certificate
AFFIDAVIT FOR LOST, STOLEN, DESTROYED STOCK CERTIFICATE
State/Province 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]
LAST WILL AND TESTAMENT
LAST WILL AND TESTAMENT OF [list name of testator]
I.
I, [list name of testator], residing at [city, prov/state of testator], being of sound mind, do hereby declare this instrument to be my last will and testament.
II.
I hereby revoke all previous wills and codicils.
III.
I direct that the disposition of my remains be as follows:
[list burial instructions]
IV.
I give all the rest and residue of my estate to my spouse, [list spouse's full name], should [she, he] survive me for 60 days.
If my spouse, [list spouse's full name], does not survive me, I give all the rest and residue of my estate to [list alternate beneficiary's name]. If neither [list spouse's full name] nor
State/Province 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]
LAST WILL AND TESTAMENT
LAST WILL AND TESTAMENT OF [list name of testator]
I.
I, [list name of testator], residing at [city, prov/state of testator], being of sound mind, do hereby declare this instrument to be my last will and testament.
II.
I hereby revoke all previous wills and codicils.
III.
I direct that the disposition of my remains be as follows:
[list burial instructions]
IV.
I give all the rest and residue of my estate to my spouse, [list spouse's full name], should [she, he] survive me for 60 days.
If my spouse, [list spouse's full name], does not survive me, I give all the rest and residue of my estate to [list alternate beneficiary's name]. If neither [list spouse's full name] nor