"Missing Record Affidavit Form" - Delaware

Missing Record Affidavit Form is a legal document that was released by the Delaware Department of Agriculture - a government authority operating within Delaware.

Form Details:

  • The latest edition currently provided by the Delaware Department of Agriculture;
  • 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Department of Agriculture.

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Download "Missing Record Affidavit Form" - Delaware

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STATE OF DELAWARE
DEPARTMENT OF AGRICULTURE
HARNESS RACING COMMISSION
2320 SOUTH DUPONT HWY
DOVER, DE 19901
agriculture.delaware.gov
TELEPHONE (302) 698-4599
FAX (302 697-6287
Missing Record Affidavit
Horse(s) Name(s): __________________________________________________________________________
Missing Record(s) Description:
(Please include type of record, name of the horse the record applies to, date of record, amount if record pertains to bills
or checks received – additional sheets may be attached if necessary)
Detailed Reason for the Missing Record(s):
(Please include the name and contact information of persons who may be able to verify- additional sheets may be
attached if necessary)
This document will be used in lieu of an invoice, canceled check, bank record or receipt. I certify that all
items listed above (and on the attached, if applicable) contain truthful, accurate information and that all
reasonable measures for obtaining an invoice, canceled check, bank record or receipt have been exhausted.
Print Name: _________________________________________ Phone: _____________________________
Address: ________________________________________________________________________________
Signature: __________________________________________ Date: _______________________________
STATE OF DELAWARE
DEPARTMENT OF AGRICULTURE
HARNESS RACING COMMISSION
2320 SOUTH DUPONT HWY
DOVER, DE 19901
agriculture.delaware.gov
TELEPHONE (302) 698-4599
FAX (302 697-6287
Missing Record Affidavit
Horse(s) Name(s): __________________________________________________________________________
Missing Record(s) Description:
(Please include type of record, name of the horse the record applies to, date of record, amount if record pertains to bills
or checks received – additional sheets may be attached if necessary)
Detailed Reason for the Missing Record(s):
(Please include the name and contact information of persons who may be able to verify- additional sheets may be
attached if necessary)
This document will be used in lieu of an invoice, canceled check, bank record or receipt. I certify that all
items listed above (and on the attached, if applicable) contain truthful, accurate information and that all
reasonable measures for obtaining an invoice, canceled check, bank record or receipt have been exhausted.
Print Name: _________________________________________ Phone: _____________________________
Address: ________________________________________________________________________________
Signature: __________________________________________ Date: _______________________________