Cashiers Check Template Pdf – Fill Out and Use This PDF

FIRST SERVICE FEDERAL CREDIT UNION

Complete and return to your local branch or mail to:

First Service Federal Credit Union, 100 Main Street, Groveport, OH 43125

For questions please call (614) 836-0100

Cashier Check AFFIDAVIT

A Notary Public is required for this Affidavit.

Please fill out and sign in front of the Notary.

Cashier Check # _________________

From account number: ____________

In the name of: ________________________________

Dated: _____________, 20______

Made payable to: _______________________________

I, ____________________________being first duly sworn on oath, depose and state that I am the

person named as _________________________on the Cashier Check from my First Service Federal

Credit Union Share Savings Account number _____________.

I, _________________, do hereby state that Cashier Check # ________ has been lost, misplaced, or

stolen. This check was dated ____________, and made payable to _________________________.

Further, I have not received the proceeds or benefit of the proceeds of said Cashier Check, nor any part thereof, directly or indirectly, and this affidavit is made voluntarily for the purpose of voiding this Cashier Check.

If the First Service Federal Credit Union Cashier Check is recovered, I will surrender it to First Service Federal Credit Union as the owner of the Cashier Check.

Notary Public (Required)

Subscribed and sworn to before to me this _______ day of _____________, 20____