AFFIDAVIT OF LOST RECEIPT
I hereby report that I have lost the receipt, or have been unable to secure a receipt
for the Auburn School District No. 408 credit card purchase identified below:
Check all that apply:
I have lost a receipt.
I have been unable to secure a receipt.
I have made several attempts to secure a receipt by contacting the vendor.
I have attached the packing slip with this form.
I have attached a portion of the product packaging (box flap, etc.) to this form.
I have attached a copy of my order form to this form.
Date of Purchase:
Account Code:
Merchant:
Amount of Purchase:
Item(s) Purchased:
Additional Comments:
This signed document will be placed on file as a substitute for the original receipt. I
understand that repeated incidences of lost receipts constitutes “misuse” of the
credit card and may result in loss of credit card privileges.
Staff Signature: Date:
________________________________ ___________________________
Deputy Superintendent Signature: Date:
Auditing Officer Signature: Date:
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
