Missing Stamp, Certificate or Journal Secretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 - http://www.FilingInOregon.com - Phone: (503) 986-2200 Print Form Reset Form CURRENT COMMISSION NUMBER: CURRENT COMMISSION NAME: EMAIL ADDRESS: (Your new certificate will be emailed to you at this address.) I, (affiant's commission name) statements are true, to the best of my knowledge: My Notary stamp or Certificate of authority to obtain a stamp , do swear affirm that the following Notary journal has been lost, misplaced, stolen or is otherwise unavailable. I do not possess the stamp, certificate or journal and do not know who possesses it or where it is located. [To Get a New Stamp and/or Certificate of Authorization] On [For Missing Journal] I discovered my journal was lost or stolen when , I request that the Secretary of State issue a new Certificate of Authorization to Obtain a stamp to me. In the event I reacquire possession of my original lost, misplaced, stolen or otherwise unavailable stamp, certificate or journal, I will notify the Secretary of State within 10 days. AFFIANT'S COMMISSION SIGNATURE STATE OF OREGON COUNTY OF SUBSCRIBED AND SWORN/AFFIRMED BEFORE ME BY ON , 20 . WITNESSING NOTARY STAMP: NOTARY PUBLIC OF OREGON [NOTE TO WITNESSING NOTARY: THE NAME AND SIGNATURE IN THE CERTIFICATE ABOVE MUST BE THE SAME AS IN THE ID YOU RELY ON.] Missing Stamp, Certificate or Journal 05/14 American LegalNet, Inc. www.FormsWorkFlow.com