Affidavit of Loss
State: Alabama
County: ________
I, the undersigned, do swear and confirm the following facts:
1. My legal name is as follows: ________.
2. My date of birth is ________.
3. My present address and telephone number are as follows:
________
________
4. I am the lawful owner of the following document: Alabama Driver's License, number ________, issued on ________.
5. On or about ________, I lost or discovered the loss of the document described above.
6. The following are the details of how I lost the document:
________
7. I am requesting a replacement of the lost document.
8. I have made all efforts to retrieve the lost document, to no avail.
9. I provided the following form of identification to the Notary Public to prove my identification:
________
10. I am aware that any false information on this Affidavit of Loss is punishable to the fullest extent of the law, up to and including monetary fine or imprisonment.
11. The below is my true and correct signature.
I swear under penalty of perjury that I am the party described above and that all statements in this Affidavit of Loss are true.
________
Signature: _____________________
Date: _________________________
State of Alabama NOTARIZATION:
State: Alabama
County: ________
On the following date: ________________________ before me personally appeared the above signatory. 5 52 5 822552 258888 82 525 225 252 82522 22 ________ 525 252 882252252 58282 88 2258225882 22282 22 22 25 252825 22 22 22 252 85888 22 852882582252 28852282 22 82 252 225822(8) 85282 2522 88 882225 525282 525 582228825225 2552 52/852/2522 25285225 252 8522.
WITNESS my hand and official seal:
Seal:
Name: __________________________________
Signature: _______________________________
My commission expires: ____________________
Affidavit of Loss
State: Alabama
County: ________
I, the undersigned, do swear and confirm the following facts:
1. My legal name is as follows: ________.
2. My date of birth is ________.
3. My present address and telephone number are as follows:
________
________
4. I am the lawful owner of the following document: Alabama Driver's License, number ________, issued on ________.
5. On or about ________, I lost or discovered the loss of the document described above.
6. The following are the details of how I lost the document:
________
7. I am requesting a replacement of the lost document.
8. I have made all efforts to retrieve the lost document, to no avail.
9. I provided the following form of identification to the Notary Public to prove my identification:
________
10. I am aware that any false information on this Affidavit of Loss is punishable to the fullest extent of the law, up to and including monetary fine or imprisonment.
11. The below is my true and correct signature.
I swear under penalty of perjury that I am the party described above and that all statements in this Affidavit of Loss are true.
________
Signature: _____________________
Date: _________________________
State of Alabama NOTARIZATION:
State: Alabama
County: ________
On the following date: ________________________ before me personally appeared the above signatory. 5 52 5 822552 258888 82 525 225 252 82522 22 ________ 525 252 882252252 58282 88 2258225882 22282 22 22 25 252825 22 22 22 252 85888 22 852882582252 28852282 22 82 252 225822(8) 85282 2522 88 882225 525282 525 582228825225 2552 52/852/2522 25285225 252 8522.
WITNESS my hand and official seal:
Seal:
Name: __________________________________
Signature: _______________________________
My commission expires: ____________________
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