"Affidavit of Lost Patent" - Arizona

Affidavit of Lost Patent is a legal document that was released by the Arizona State Land Department - a government authority operating within Arizona.

Form Details:

  • Released on April 1, 2004;
  • The latest edition currently provided by the Arizona State Land Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Arizona State Land Department.

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RETURN TO:
DEPARTMENTAL USE ONLY
ARIZONA STATE LAND DEPARTMENT
PUBLIC COUNTER
ACCOUNTING
1616 WEST ADAMS
PHOENIX, ARIZONA 85007
Filing Fee: $50
Certified copy made.
SUBMIT FILING FEE: $50*
*Filing Fees Are Non-Refundable
____________________
M(31)
Initial
/
Date
AFFIDAVIT OF LOST PATENT
FOR RECORDING PURPOSES ONLY
INSTRUCTIONS
Type or print in ink.
1. Complete form, sign and have signature notarized.
STATE OF
)
PATENT NO.
-
) ss
COUNTY OF
)
, being first duly sworn on oath, deposes and says that said Patent
issued to
on
was not recorded with the _______________ County
Recorder’s Office. In order to clear title on land described in above referenced Patent, a certified copy of the afore
mentioned document is being requested for recording purposes only.
Signature
Date
______________________________________________
Title
Subscribed and sworn to before me, this
day of
, ________.
Notary Public
(SEAL)
My Commission Expires
04/2004- Affidavit
RETURN TO:
DEPARTMENTAL USE ONLY
ARIZONA STATE LAND DEPARTMENT
PUBLIC COUNTER
ACCOUNTING
1616 WEST ADAMS
PHOENIX, ARIZONA 85007
Filing Fee: $50
Certified copy made.
SUBMIT FILING FEE: $50*
*Filing Fees Are Non-Refundable
____________________
M(31)
Initial
/
Date
AFFIDAVIT OF LOST PATENT
FOR RECORDING PURPOSES ONLY
INSTRUCTIONS
Type or print in ink.
1. Complete form, sign and have signature notarized.
STATE OF
)
PATENT NO.
-
) ss
COUNTY OF
)
, being first duly sworn on oath, deposes and says that said Patent
issued to
on
was not recorded with the _______________ County
Recorder’s Office. In order to clear title on land described in above referenced Patent, a certified copy of the afore
mentioned document is being requested for recording purposes only.
Signature
Date
______________________________________________
Title
Subscribed and sworn to before me, this
day of
, ________.
Notary Public
(SEAL)
My Commission Expires
04/2004- Affidavit