Lost Promissory Note Affidavit


STATE OF ____________________

COUNTY OF __________________

PERSONALLY appeared before me the undersigned authority the undersigned __________________, (“Affiant”) who, upon being duly sworn, states on his/her oath as follows:

  1. Affiant is the _____________ of _________________ and makes this Affidavit in such capacity.
  2. That the original ______ Note dated _________________, in the amount of ________________ Dollars ($ _______________), with interest of ____% per annum, executed by _____________________ and ______________________, Husband and Wife, to ___________________, beneficiary and secured by that certain Deed of Trust dated ___________________, and recorded in the office of the ___________ of ____________County, ___________, in Book _____ at Page _______, has been lost. The Note provides for payments on the amount of monthly, beginning on the _____ day of ______________, 20___ and continuing on the same say of each month thereafter until the day of , when all remaining principal and interest is due. [A copy of the Promissory Note is attached hereto is a true and correct copy of the original Note] [A copy of the original promissory note is not available but affiant would state that the terms of the promissory note stated above are true and correct as reflected by _________________.]
  3. _________________________ is the current holder of the Note and the Note, nor any part thereof, has been assigned to any other person or entity.
  4. The balance due on the note as of the ____ day of ____________, 20___, is ___________________ principal, _______________ interest and ____________________, for a total of ____________________ dollars payoff.
  5. __________________________ agrees to indemnify and hold any person who relies on this Affidavit from double payment or collection of said Promissory, including costs and attorney fees, except one full payment to______________________ , the current legal holder.

WITNESS my signature this the ___ day of ______________, 20 ____.




SWORN TO AND SUBSCRIBED BEFORE ME, this the ___ day of __________, 20 ___.

Witness my signature and official seal.



My Commission Expires:


State Specific Affidavit Forms

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Inside Lost Promissory Note Affidavit