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.

Protect yourself and your property by using our attorney-prepared forms.

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