Lost Check Affidavit

Affidavit Concerning Lost Check
Please follow these directions for filling out the affidavit for lost or stolen check.
1.Please do not fill out the top section of the form, this is for the
Member Benefits department
2.Complete the middle section titled “Information below to be complete
by the payee.” Fill out the form using your current mailing address; do
not forget to add the zip code.
3.Wait to sign the document until a Notary documents your
identification. The form must be signed by a notary, if the form is
returned without the notary signature, the form will be sent back to
you for completion.
4.The affidavit will put a stop payment on the initial check, if you find or
receive the check in question please destroy or return it to the
Member Benefits Department.
5.Mail or return the completed affidavit to: The Klamath Tribes,
Member Benefits Department, P.O. Box 436, Chiloquin, OR 97624.