ORDER
FORM Print this form, fill it out and send it to us with
your information
Lost or Stolen
Passport Statement
*Note: You must fill this form out if
you have lost your passport. This letter will
accompany your "Lost or Stolen Form" (DSP-64).
Houston Passport Agency
1919 Smith Street
Suite 1100
Houston, Texas 77002
Dear Passport Representative,
Please be advised, I
, was issued a
valid US Passport
on :
,
,
Please note, my passport has been lost or stolen and
I can not locate it. Please be advised that I now have an urgent immediate
international departure from the USA and I need to apply for a new
passport. I will be departing from the USA on:
I am now requesting that you please issue
another passport to me, so I can use it for my trip. If in the event
while traveling overseas I misplace my passport I will immediately
contact the closest US Embassy. If in the event while traveling domestically
I misplace my passport I will contact the closest US Passport Office
or the US State Department.
Thank you for your assistance in this urgent matter.