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Affidavit--Unauthorized Signature Or Endorsement
AFFIDAVIT--UNAUTHORIZED SIGNATURE OR ENDORSEMENT
State of [State of Jurisdiction]
County of [County of Jurisdiction]
I, [Name of depositor], after being sworn on oath, affirm that I reside at [address of depositor], [city of depositor], [state of depositor]. On [date], I was shown check number [Number of check], dated [Date of check], for the amount of $[Amount of the check]. The check was payable to [Name of payee], and was drawn on [account number and name of bank].
I have examined the signature or endorsement on the check described above. Though the signature or endorsement purports to be mine, it is a forgery. I did not execute the instrument, nor did I authorize another person to execute it on my behalf. I have received no benefits from the proceeds of the check. I make this affidavit to induce [Name of the bank] to reimburse me in the check amount of $[Amount of reimbursement].
State of [State of Jurisdiction]
County of [County of Jurisdiction]
This instrument was acknowledged before me on [date], by [name(s) of person(s)].
[Signature of notarial officer]
(Seal)
[Title or rank of officer]
My commission expires:[Commission expires]