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Lost Check Affidavit Law 138 - Florida
| Lost Check Affidavit Form. This is a Florida form and can be used in General Brevard Local County . |
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IN THE CIRCUIT COURT,EIGHTEENTH JUDI CIALCIRCUIT,BREVARD COUNTY,FLORIDA IN THE COUNTYCOURT, BREVARD COUNTY, FLORIDA DIVISION CASE NUMBER CIVIL CRIMINAL LOST CHECK AFFIDAVIT -- - - JUVENILE TRAFFIC CLOCKIN PLAINTIFF DEFENDANT LOST CHECK INFORMATION NAME OF PAYEE CHECK NUMBER DATE OF CHECK AMOUNT OF CHECK STATE OF FLORIDA COUNTYOF BREVARD BEFORE ME this day personally appeared _________________________________________________,who, being duly sworn, deposes and says that to this date, he/she has not received the above referenced check. If said check isreceived after the signing of this affidavit, it will be mailed immediately to the Clerks office. AFFIANT SIGNATURE AFFIANT ADDRESS PHONE NUMBER SWORN to and SUBSCRIBED before me this __________ day of ________________________20_____ . NOTARYPUBLIC/DEPUTY CLERK STOP PAYMENT ISSUED TO BOOKKEEPING _________________ CHECKCASHED____________________ REPLACEMENT CHECK NUMBER __________________________ REPLACEMENT CHECK DATE _____________________________ LAW 138 (REV. 02/00)
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