STATE OF 

COUNTY OF 

, of , , , , being duly sworn, hereby swears and affirms as follows: 

1. is an authorized officer, representative, or agent of , which is the sole holder (the "Holder") of the promissory note dated , in the amount of $ and signed by   (the "Borrower") in favor of as beneficiary (the "Original Note").


2. The Original Note has been inadvertently loststolendestroyed. The Holder has made the following efforts to locate the Original Note:The destruction of the Original Note occurred as follows: ..


3. The Original Note provides for monthlyquarterlyone lump-sum payment(s) in the amount of $, with these payments beginning on  and continuing until the principal and interest have been paid in full, with these payments beginning on  and continuing until the principal and interest have been paid in full.

4. The balance remaining under the Original Note as of  is $.

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.


7. A correct copy of the Original Note is attached as Exhibit A to this affidavit.A copy of the Original Note is not available, but the Holder hereby states that the terms of the Original Note as stated in this affidavit are correct.

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.





The Holder is signing this affidavit on the date set forth below.

Date: ______________________

______________________________________
Signature of


STATE OF 
COUNTY OF 
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:  ___________________________

[PAGE BREAK HERE]








EXHIBIT A
Attach copy of Original Note.

 

FREE
ATTORNEY-DRAFTED

Affidavit of Lost Promissory Note - Free Template

Lost your promissory note? Use an affidavit of lost promissory note and simplify the process of replacing your lost loan proof.

Complete your document with ease

    Fill and download for free
    Answer guided questions to create and download your document quickly
    Customize
    Personalize your document to meet your needs with a rich editor (additional fee)
    Sign electronically
    Self-sign or request signatures online securely in just a few clicks (additional fee)

What's an affidavit of lost promissory note?

Whether you keep your promissory note in a safe or a shoe box, there's always a chance it could get lost or damaged. A promissory note is proof a loan's been made, and an affidavit is a promise that what you're signing is accurate. Creating new documents would have to start with an affidavit of lost promissory note.

Here's the information you'll need to have handy to complete your affidavit of lost promissory note:
- How much the promissory note was for : Know the principal amount and how payments were made.
- What happened to the promissory note : Was it lost, stolen, or destroyed.