Affidavit In Lieu Of Lost Receipt Of United States INS For Collateral Accepted As Security
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Affidavit In Lieu Of Lost Receipt Of United States INS For Collateral Accepted As Security Form. This is a Official Federal Forms form and can be use in US Citizenship And Immigration Services.
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Tags: Affidavit In Lieu Of Lost Receipt Of United States INS For Collateral Accepted As Security, I-395, Official Federal Forms US Citizenship And Immigration Services,
Affidavit In Lieu of Lost Receipt of
United States INS for Collateral
Accepted As Security
U.S. Department of Justice
Immigration and Naturalization Service
State of
If Known: Bonded Alien A Number
County of
Date and Place of Birth
Receipt Number
I,
) hereby duly sworn, depose and say:
(Obligor's Name)
That I reside at:
(Number)
(Street)
(City)
(State)
That I am the surety on an immigration bond executed in behalf of
at
(Zip Code)
(Alien's Name)
on
(Office where bond was posted)
(Date bond was posted)
That as collateral security under such bond I deposited with the Immigration and Naturalization Service certain
securities as follows: (Amount of Bond)
That the receipt which was issued to me on the same day by the Immigration and Naturalization Service for such
collateral security has been lost under the following circumstances: (Reason for loss of original I-305)
That if the said receipt is located, I promise to see that it is surrendered to the Immigration and Naturalization Service;
That there are no other claimants to the said collateral security and I have not assigned the same or any part thereof or
any interest therein to any other party;
That I, on behalf of myself, my heirs, administrators, executors or assigns, will protect the government of the
United States and any of its agencies, officers and employees and save them harmless from any claim,
loss or liability whatsoever which may or might arise by reason of the surrender to me of the said collateral security
without my producing the receipt issued therefore.
Signature
Subscribed and sworn to before me
At:
(Location)
On:
Obligor Taxpayer Identification Number
(Social Security Number)
(Date)
Notary Seal
NOTARY PUBLIC (Signature):
MY COMMISSION EXPIRES ON:
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Form I-395 (Rev. 03/05/02)
