USVI Public Records

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GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES CHARLOTTE AMALIE, ST. THOMAS, V.I. 00801 -----0----- Department of Finance AFFIDAVIT OF LOST CHECK-----AGREEMENT OF INDEMNITY Whereas, the Commissioner of Finance of the Virgin Islands has caused to be issued and delivered to me a certain check No. _____________dated the ____ day of _______________, 20_____ in the sum of $____________ drawn on (Name of Bank) _____________________________________. Whereas, the undersigned has represented to the Commissioner of Finance of the Virgin Islands and now declares that said check has been mislaid, lost, destroyed, not received or bears a signature that is either unacceptable to the bank or not legible and has therefore applied to said Commissioner to issue a replacement check which said Commissioner has consented to do (after a 10 day waiting period) upon receiving the indemnity hereinafter contained: Now, therefore, the said (Name of Payee) __________________________________________ doth hereby agree to save harmless and indemnify the Government of the Virgin Islands from and against all claims and demands in respect to the said check; and from and against all damages, losses, cost, charges and expense which the Government may sustain, incur or be liable for in consequence of it having issued a second check in lieu of the one above described. And the undersigned further agrees to return said check to the Commissioner of Finance forthwith if same shall be found. Name (print):__________________________________________ Signature:_____________________________________________ Date:_____________________________________ MailingAddress:_______________________________________ _______________________________________ _______________________________________ Telephone No:_________________________________________ Subscribed and sworn before me this: _______day of ______________________20_____ __________________________________________ Notary Public