"Affidavit of Lost License" - Delaware

Affidavit of Lost License is a legal document that was released by the Delaware Department of Insurance - a government authority operating within Delaware.

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Office of the
Delaware
Commissioner
Department of Insurance
AFFIDAVIT OF LOST LICENSE
I, _______________________________________, in my capacity as ________________________________________________
(Name)
(Title)
of _____________________________________________ hereby certify that I am the keeper of the corporate
(Company Name)
records for ________________________________________ and that a diligent search has been made for License No.
(Company Name)
____________________ issued by the Delaware Department of Insurance.
(License #)
This said License issued in ___________________ cannot be located and is considered lost, misplaced or destroyed.
(Date of Licensure)
In the event that the original License is ever located it will be immediately returned to the Delaware Department of
Insurance.
DATED this
day of
, 20
(Signature)
STATE OF
)
COUNTY OF
)
Personally appeared before me the above named
, personally
known to me, who, being duly sworn, deposes and says that he/she executed the above instrument and that the statements and
answers contained therein, are true and correct to the best of his/her knowledge and belief.
Subscribed and sworn to before me this
day of
, 20
(Notary Public)
(SEAL) My commission expires:
1351 West North Street, Dover, DE 19904-2465 • www.insurance.delaware.gov
(302) 674-7300 Dover • (302) 739-5280 fax • (302) 577-5280 Wilmington
Office of the
Delaware
Commissioner
Department of Insurance
AFFIDAVIT OF LOST LICENSE
I, _______________________________________, in my capacity as ________________________________________________
(Name)
(Title)
of _____________________________________________ hereby certify that I am the keeper of the corporate
(Company Name)
records for ________________________________________ and that a diligent search has been made for License No.
(Company Name)
____________________ issued by the Delaware Department of Insurance.
(License #)
This said License issued in ___________________ cannot be located and is considered lost, misplaced or destroyed.
(Date of Licensure)
In the event that the original License is ever located it will be immediately returned to the Delaware Department of
Insurance.
DATED this
day of
, 20
(Signature)
STATE OF
)
COUNTY OF
)
Personally appeared before me the above named
, personally
known to me, who, being duly sworn, deposes and says that he/she executed the above instrument and that the statements and
answers contained therein, are true and correct to the best of his/her knowledge and belief.
Subscribed and sworn to before me this
day of
, 20
(Notary Public)
(SEAL) My commission expires:
1351 West North Street, Dover, DE 19904-2465 • www.insurance.delaware.gov
(302) 674-7300 Dover • (302) 739-5280 fax • (302) 577-5280 Wilmington