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Print Form LOST LICENSE/CERTIFICATE AFFIDAVIT Name of Licensee/Registrant: Main Office Address: Date: Rhoda L. Ricketts Deputy Superintendent New York State Department of Financial Services Mortgage

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What is lost licensecertificate affidavit?

A lost licensecertificate affidavit is a legal document used to report and confirm the loss or theft of a license or certificate.

Who is required to file lost licensecertificate affidavit?

Anyone who has lost or had their license or certificate stolen is required to file a lost licensecertificate affidavit to report the incident.

How to fill out lost licensecertificate affidavit?

To fill out a lost licensecertificate affidavit, you will need to provide your personal details, information about the lost or stolen license or certificate, and any supporting documentation of the incident.

What is the purpose of lost licensecertificate affidavit?

The purpose of a lost licensecertificate affidavit is to report the loss or theft of a license or certificate to the relevant authority and to request a replacement document.

What information must be reported on lost licensecertificate affidavit?

The lost licensecertificate affidavit should include details such as your name, contact information, a description of the lost or stolen license or certificate, the date and circumstances of the loss or theft, and any relevant identification numbers.

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