Passport and Visa Specialists
2600 South Gessner Rd. Suite 200
Houston, Texas 77063
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
Houston, Texas 77002
Dear Passport Representative,
Please be advised, I______________________________, was issued a valid US Passport
(your full name here)
on day:_____________, month:__________________, year:_____________.
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.