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#1556112 - 05/24/11 08:46 PM Declaration of Loss
lherb Offline
Member
Joined: Oct 2007
Posts: 78
Indiana
Cound someone point me in the right direction in obtaining a "Declaration of Loss" form that can be used in the State of Indiana? thank you!

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#1556285 - 05/25/11 01:39 PM Re: Declaration of Loss lherb
Dan Persfull Offline
10K Club
Dan Persfull
Joined: Aug 2002
Posts: 47,517
Bloomington, IN
IC 26-1-3.1

http://www.in.gov/legislative/ic/code/title26/ar1/ch3.1.html

Sample Agreement.

INDEMNITY AGREEMENT FOR MISSING INSTRUMENT

Date: __________________

DESCRIPTION OF INSTRUMENT

Type of Instrument ____________ Number ______________ Dated _________________
Amount of Instrument ____________________ Payee ____________________________

The undersigned hereby certifies that the above described instrument, which was issued by ABC Bank on behalf of the undersigned, has been lost, mislaid, destroyed or stolen, and that after due and diligent search, it cannot be found. The undersigned further certifies that said instrument was not endorsed, sold, negotiated, assigned, transferred or deposit under any agreement or subjected to any hypothecation, lien or pledge, or in any other manner disposed of by separate assignment or otherwise. The undersigned agrees that if the said instrument is located in the future, it will not be endorsed or negotiated, assigned, transferred or deposit under any agreement or subjected to any hypothecation, lien or pledge, or in any other manner disposed of by separate assignment or otherwise. The undersigned agrees that if the said instrument is located in the future, it will not be endorsed or negotiated in any manner, but will be immediately delivered to ABC Bank for cancellation without value.

In consideration of the issuance of a replacement instrument or the refund of the amount involved to the undersigned, the undersigned hereby indemnifies and agrees to save and hold ABC Bank harmless against all claims, damages, actions, proceedings, demands, losses and liability, whether groundless or otherwise, including all expenses of or on account of the issuance of a replacement instrument or the refund of the amount thereof.

The liability of the undersigned hereunder shall be joint and several and shall be binding upon the heirs, successors and assigns, and personal representatives of the undersigned.

Type or Print Name: ___________________ Type or Print Name: _________________

Signature: ___________________________ Signature: _________________________
_________________________
The opinions expressed are mine and they are not to be taken as legal advice.

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