How do I complete the deceased-owner lost instrument affidavit?

Enter the deceased owner’s account and institution details, the amount, and the requested payee. Sign the affidavit before a notary, then submit it to the appropriate agency.

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

Yes. The form includes a subscribed-and-sworn jurat, so the claimant signs before a notary public.

Can I use a commissioned online notary?

The form calls for notarization but does not specify online notarization. Confirm with the receiving agency or the Recorder of Deeds if unsure.

What does the claimant agree to in the affidavit?

The claimant requests payment and agrees to indemnify the administrator for losses from claims based on reliance on the affidavit, including related costs and expenses.

Office of the Lieutenant Governor, VI · St. Thomas

Affidavit of Lost Instrument (Deceased Owner)

This affidavit lets a claimant request payment of a presumed-abandoned account held in trust when the deceased record owner’s passbook or other account instrument cannot be located.

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 claimant identifies the deceased account owner, the account and institution, and the amount held in trust. The affidavit states that the claimant could not locate the passbook or other instrument after due diligence, requests payment, and accepts responsibility for losses and claims tied to the administrator’s reliance on the affidavit. The Office of the Lieutenant Governor’s Division of Banking, Insurance and Financial Regulation provides this form for claims involving deceased owners.

Who needs it

A claimant seeking payment of a presumed-abandoned account held in trust after the deceased record owner’s passbook or other instrument cannot be found needs this affidavit.

Why it needs a notary

The form has a subscribed-and-sworn jurat, and the claimant signs the affidavit before a notary public.

How to get this notarized

1
Download The Affidavit
Download the Office of the Lieutenant Governor’s Affidavit of Lost Instrument for a deceased owner.
2
Fill In The Account Details
Complete the account, institution, amount, and payee information, and review the claimant’s statements.
3
Book An Online Notary
Arrange a session with a commissioned online notary, and confirm acceptance with the receiving agency if needed.
4
Sign On Video
Sign the affidavit during the video session when directed by the notary.
5
Submit The Affidavit
Submit the notarized affidavit to the appropriate 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.

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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.