Affidavit of Loss - Idaho

A F F I D A V I T O F L O S S
I hereby certify that I am the holder of State Lease No. ____________________; that
I have never assigned nor transferred said lease; further, that the lease has been lost, and
after diligent search cannot be found.
______________________________
______________________________
STATE OF
)
: ss
County of __________________ )
he/she/the
y
On this
day of , in the year 20 , before me, a
notary public in and for said State, personally appeared
, known to me to be the person(s) that executed the
within instrument, and acknowledged to me that _______ executed the same.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on the day and year
last above written.
Notary Public
Residing at:
My Commission Expires:
Page 1/1
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