Affidavit of Lost Promissory Note and Indemnity Agreement
2. The Original Note has been inadvertently
3. The Original Note provides for
4. The balance remaining under the Original Note as of
5. Neither the Original Note nor any part of the Holder's rights in the Original Note has, in whole or in part, been sold, transferred, or assigned to any other person or entity.
6. The existence and terms of the Original Note have not been contested by the Borrower and all conditions of the loan agreement between the Holder and the Borrower have otherwise been met.
8. If the Holder locates the Original Note, or if it is otherwise returned to the Holder, the Original Note will have no value and the Holder will surrender the Original Note to the Borrower immediately and without consideration.
9. The Holder asks, and is making this affidavit for the purpose of requesting, that the Borrower execute a duplicate note as a substitute for the Original Note.
10. In consideration of the above, the Holder shall:
- (a) release the Borrower from all claims, suits, or causes of action the Holder may have against the Borrower relating to the Original Note or the Borrower's compliance with the Holder's request in this affidavit; and
- (b) indemnify the Borrower against all losses relating to:
- (i) the issuance and delivery of a new note;
- (ii) any payment, transfer, delivery, exchange, or other act related to the Original Note, whether done by accident, oversight, or neglect, or whether made or done on presentation of the Original Note, without contesting the propriety of that payment, transfer, delivery, exchange, or other act;
- (iii) the Original Note or the Company's compliance with the Holder's request in this affidavit; or
- (iv) any breach or violation of a representation or covenant in this affidavit.
The Holder is signing this affidavit on the date set forth below.
|Subscribed and sworn to before me this __________day of ____________, 20_____, at ___________, __________________.|
|Signature of Notary Public|
|Name of Notary Public: ____________________________||(SEAL)|
|Notary Public, State of
|My commission expires: ___________________________|
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