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Affidavit of Lost or Destroyed Receipt - PCard

  1. Affidavit of Lost of Destroyed Receipt - PCard

  2. I understand that falsification of the itemization of this purchase constitutes an act of fraud:

    I declare on oath that the original receipt(s) in the below itemized listing has been lost or destroyed. The vendor has been contacted and is not able to provide a duplicate receipt for this purchase.

  3. Signature

  4. Leave This Blank:

  5. This field is not part of the form submission.