I state under oath that the original of this document is now LOST or NOT IN POSSESSION of the party seeking to now record the same. State of New York Title No. ss: County of ______ Account No.______.Confirm under oath that a court document was lost. An affidavit is a sworn statement of fact that can be used in a variety of legal proceedings, from bankruptcy cases to family and civil litigation matters. Recover lost promissory notes with ease. Affidavit of Lost, Missing or Stolen Check (This form replaces CCG 0693). Affidavit of Lost, Missing or Stolen Check (This form replaces CCG 0693). Ensure that DSU police have been notified and a police report filed on the missing item(s), get a copy of the report prior to completing the affidavit. Please be aware that forms will be displayed in a NEW browser window. Notarization is required to have a replacement check issued.