Lost or Stolen Passport Statement

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,” which is (DSP-64).

  • Houston Passport Agency
    1919 Smith Street
    Houston, Texas 77002


    Dear Passport Representative,

    Please be advised, I, named immediately below...
  • (or "none" / "unknown")
  • (or "none")
  • ...was issued a valid US Passport on:

  • Please note, my passport has been lost or stolen, and I cannot 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.

    Sincerely,


    ___________________________________________
    Signature

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