Declaration Regarding Lost Share Certificate

for Your State

This Declaration Regarding Lost Share Certificate is used by a shareholder who has lost or misplaced a stock certificate. This declaration sets out the specifics regarding the shares and must be signed in front of a notary.

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This Declaration Regarding Lost Share Certificate is for use by a shareholder who has lost a stock certificate. This declaration sets out the names of the corporation and shareholder, the number of the certificate and number of shares issued under the certificate. It also sets forth a declaration that the shares were not assigned or sold and that the certificate was mislaid, misplaced or inadvertently destroyed. A Declaration Regarding Lost Share Certificate will prove useful in the event the shareholder desires to either sell or vote the shares at a corporate meeting. This Declaration must be signed by the shareholder in the presence of a notary public.

This Declaration Regarding Lost Share Certificate includes the following:
  • Shareholder: Sets forth the names of the shareholder, corporation issuing the shares, lost certificate number and number of shares;
  • Declaration: Sets forth that shareholder has not sold or disposed of the shares and that the certificate has been misplaced, lost or destroyed;
  • Signature: The shareholder must sign the certificate in front of a notary public.

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This attorney-prepared packet contains:
  1. General Instructions
  2. Declaration Regarding Lost Share Certificate
State Law Compliance: This form complies with the laws of all states
Number of Pages4
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#28508

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