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WHEREAS, I, {name} am the owner of {number} shares of {corporation name} stock.
WHEREAS, despite my best efforts and searches, I am unable to locate the stock certificates numbered {numbers of stock certificates}.
WHEREAS, I agree to release and hold harmless {corporation name} from any claims of ownership or other legal actions that occur as a result of this loss.
WHEREAS, I will return the lost stock certificate should I locate them at any point in the future.
THEREFORE, I am requesting that {corporation name} reissue {number} stock certificates in my name.
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