How do I complete this lost-instrument affidavit?

Identify the owner and account, provide the power-of-attorney details, explain that you could not locate the instrument, and complete the payment request. Sign and swear to the affidavit before a commissioned online notary.

Do I need to sign this affidavit in front of a notary?

Yes. The form says it must be subscribed and sworn before a notary public. The attorney-in-fact should sign before the notary and complete the notarial certificate.

Can I use an online notary for this form?

A commissioned online notary may perform the notarization, but the form does not address remote notarization. Confirm acceptance with the receiving agency or the Recorder of Deeds if unsure.

What should I include with the affidavit?

The form refers to an attached copy of the power of attorney. It also asks for information about the owner, account, institution, balance, and requested payment.

Office of the Lieutenant Governor, VI · St. Thomas

Affidavit of Lost Instrument (Power of Attorney)

This affidavit lets an attorney-in-fact request payment of an abandoned account held in trust after being unable to locate its passbook or other instrument.

Simple form~10 min to notarize

licensed online notary
~15 min average
Notarized PDF emailed

What you’ll need

Government-issued photo ID
Webcam-enabled device (laptop or phone)
This form, ready to upload as a PDF

Form previewView full PDF →

What this form is

The attorney-in-fact uses this form to affirm their appointment, identify the owner and account, explain that the account instrument could not be located, and request payment from the Administrator. It also includes an agreement to indemnify the Administrator for losses or claims arising from reliance on the affidavit. The form is for requests involving an account presumed abandoned and held in trust, as described in the form.

Who needs it

An attorney-in-fact seeking payment of an account presumed abandoned and held in trust who cannot locate its passbook or other instrument needs this affidavit.

Why it needs a notary

The form carries a subscribed-and-sworn jurat, so the attorney-in-fact must sign and swear to the affidavit before the notary.

How to get this notarized

1
Download The Affidavit
Get the Affidavit of Lost Instrument (Power of Attorney) from the Office of the Lieutenant Governor.
2
Complete The Form
Enter the attorney-in-fact, owner, power-of-attorney, account, and payment details; attach a copy of the power of attorney.
3
Book An Online Notary
Arrange a session with a commissioned online notary and have identification ready.
4
Sign On Video
Sign and swear to the affidavit during the online notary session; complete the notary section.
5
Submit The Affidavit
Send the completed affidavit and attached power of attorney to the receiving agency.

Preview the form

The blank PDF straight from Office of the Lieutenant Governor. Look it over, then upload your filled copy to start the notary session.

Open in new tab

You’ll need ID and a webcam.

A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.