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.



Please print
Set your Twitter account name in your settings to use the TwitterBar Section.