Affidavit of Government ID Loss

Under State Laws: (State Name)

Country Name: (goes here)
Purpose of Affidavit: (goes here)
Date: (goes here)

I, _______________________________, Citizenship, with legal age _____, and permanent

resident of ___________________, under the law hereby sworn, dispose and state that:

1. My Government identity number _________ with issuance from

___________________.
2. On following date ___________________, and following location
________________________, discovered that my Government identity card was lost.
3. Even after diligent attempts of search, I could not locate nor find my Government
identity card and think it is lost truly.
4. Therefore, I am filing this affidavit of loss for all the legal purposes it may serve for the
replacement and reissuance of my Government identity card.

Signature of Affiant: ________________________________

Notary Signature & Stamp: ___________________________

Affidavit of Loss