Affidavit of Loss
State: Alabama
County: ________
I, the undersigned, do swear and confirm the following facts:
1. My legal name is as follows: ________.
2. My date of birth is ________.
3. My present address and telephone number are as follows:
________
________
4. I am the lawful owner of the following document: Alabama Driver's License, number ________, issued on ________.
5. On or about ________, I lost or discovered the loss of the document described above.
6. The following are the details of how I lost the document:
________
7. I am requesting a replacement of the lost document.
8. I have made all efforts to retrieve the lost document, to no avail.
9. I provided the following form of identification to the Notary Public to prove my identification:
________
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11. The below is my true and correct signature.
I swear under penalty of perjury that I am the party described above and that all statements in this Affidavit of Loss are true.
________
Signature: _____________________
Date: _________________________
State of Alabama NOTARIZATION:
State: Alabama
County: ________
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WITNESS my hand and official seal:
Seal:
Name: __________________________________
Signature: _______________________________
My commission expires: ____________________