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AFFIDAVIT - UNAUTHORIZED SIGNATURE OR ENDORSEMENT

 

State of: ____________________

County of: ____________________

I, ___________________ (depositor), being first duly sworn, affirm that I reside at _____________________________ (address), _______________________ (city), ________________ County, _____________________ (state). On _____________ (date), I was shown check number __________, dated _____________, for the amount of $__________. The check was payable to ______________________ (payee), and was drawn on ___________________________________ (account number and name of bank).

I have examined the _________________________ (signature or endorsement) on the check described above. Though the _____________________________ (signature or endorsement) purports to be mine, it is a forgery. I did not execute the instrument, nor did I authorize another person to execute it on my behalf. I have received no benefits from the proceeds of the check. I make this affidavit to induce ___________________ (bank) to reimburse me in the check amount of $__________.

State of: ______________________

County of: _____________________

This instrument was acknowledged before me on ___________________ (date), by,

_____________________________________________________

(name(s) of person(s)).

________________________________

(Signature of notarial officer)

________________________________

(Seal)

_______________________________

(Title or Rank of Officer)

(My commission expires: ______________)

 

 

Warning:    

These forms are provided AS IS.  They may not be any good.  Even if they are good in one jurisdiction, they may not work in another.  And the facts of your situation may make these forms inappropriate for you.  They are for informational purposes only, and you should consult an attorney before using them.

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