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Affidavit In Lieu Of Lost Receipt Of United States INS For Collateral Accepted As Security I-395 - Official Federal Forms
| Affidavit In Lieu Of Lost Receipt Of United States INS For Collateral Accepted As Security Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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U.S. Department of Justice Immigration and Naturalization Service Affidavit In Lieu of Lost Receipt of United States INS for Collateral Accepted As Security State of County of If Known: Bonded Alien A Number Date and Place of Birth Receipt Number I, (Obligor's Name) ) hereby duly sworn, depose and say: (Street) (City) (State) (Zip Code) That I reside at: (Number) That I am the surety on an immigration bond executed in behalf of at (Office where bond was posted) (Alien's Name) on (Date bond was posted) That as collateral security under such bond I deposited with the Immigration and Naturalization Service certain securities as follows: (Amount of Bond) That the receipt which was issued to me on the same day by the Immigration and Naturalization Service for such collateral security has been lost under the following circumstances: (Reason for loss of original I-305) That if the said receipt is located, I promise to see that it is surrendered to the Immigration and Naturalization Service; That there are no other claimants to the said collateral security and I have not assigned the same or any part thereof or any interest therein to any other party; That I, on behalf of myself, my heirs, administrators, executors or assigns, will protect the government of the United States and any of its agencies, officers and employees and save them harmless from any claim, loss or liability whatsoever which may or might arise by reason of the surrender to me of the said collateral security without my producing the receipt issued therefore. Signature Subscribed and sworn to before me At: (Location) On: (Date) Obligor Taxpayer Identification Number (Social Security Number) Notary Seal NOTARY PUBLIC (Signature): MY COMMISSION EXPIRES ON: American LegalNet, Inc. www.USCourtForms.com Form I-395 (Rev. 03/05/02)
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