Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Fill in the 'State' section with your current state of residence. This should reflect where you are located.
3. Complete the 'County' section by entering your county of residence. This is important for jurisdiction purposes.
4. In the 'I, __________, residing at __________' section, write your full name in the first blank and your complete address in the second blank.
5. Choose your card status by marking the appropriate box: 'Lost', 'Stolen', 'Not Received', 'Card in Possession', or 'Other'. If you select ‘Other’, please provide an explanation in the comments section.
6. Enter your account number in the designated field. Ensure that this information is accurate to avoid processing delays.
7. Attach a list of all fraudulent transactions or a copy of the statement with disputed charges clearly marked. This documentation supports your claim.
8. Acknowledge your agreement to provide information about unauthorized account use by signing the areas for primary and secondary cardholders as applicable.
9. Complete the notarization section by having a notary public sign and date the document. This step is essential for validating your affidavit.
10. Finally, review all the information you've entered, make any necessary corrections, and then choose to save changes, download, print, or share the form.

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