Form 6113 "Affidavit of Lost Lease, Permit or Contract" - Arizona

What Is Form 6113?

This is a legal form that was released by the Arizona State Land Department - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2000;
  • The latest edition provided by the Arizona State Land Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 6113 by clicking the link below or browse more documents and templates provided by the Arizona State Land Department.

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Download Form 6113 "Affidavit of Lost Lease, Permit or Contract" - Arizona

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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 LEASE, PERMIT OR CONTRACT
INSTRUCTIONS
Type or print in ink.
1. Complete form, sign and have signature notarized.
2. Affidavit must be signed by the State Lessee(s),
Permittee(s), or Grantee(s) of record.
STATE OF
)
SLD CONTRACT NO.
-
)
COUNTY OF
)
, being first duly sworn on oath, deposes and says that
(Name)
(He/She/They)
is/are the identical person(s) who is/are the
of the lands in the above referenced
{Lessee(s), Permittee(s), or Grantee(s)}
contract; that the original document or partial document has been lost; that a diligent search for the lease has
been made, but applicant is unable to locate same; that
has/have not, at any time, transferred
)
(He/She/They
or delivered said contract to anyone whomsoever; that if said lease, permit or contract is found,
(
He/She/They)
will immediately surrender same to the State Land Department.
Signature
Subscribed and sworn to before me, this
day of
, 20
.
Notary Public
(SEAL)
My Commission Expires
6113 03/92 (Rev. 01/2000) - 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 LEASE, PERMIT OR CONTRACT
INSTRUCTIONS
Type or print in ink.
1. Complete form, sign and have signature notarized.
2. Affidavit must be signed by the State Lessee(s),
Permittee(s), or Grantee(s) of record.
STATE OF
)
SLD CONTRACT NO.
-
)
COUNTY OF
)
, being first duly sworn on oath, deposes and says that
(Name)
(He/She/They)
is/are the identical person(s) who is/are the
of the lands in the above referenced
{Lessee(s), Permittee(s), or Grantee(s)}
contract; that the original document or partial document has been lost; that a diligent search for the lease has
been made, but applicant is unable to locate same; that
has/have not, at any time, transferred
)
(He/She/They
or delivered said contract to anyone whomsoever; that if said lease, permit or contract is found,
(
He/She/They)
will immediately surrender same to the State Land Department.
Signature
Subscribed and sworn to before me, this
day of
, 20
.
Notary Public
(SEAL)
My Commission Expires
6113 03/92 (Rev. 01/2000) - Affidavit