Fillable AFFIDAVIT OF LOST RECEIPT (Idaho State University)

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AFFIDAVIT OF LOST RECEIPT (Idaho State University)

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The AFFIDAVIT OF LOST RECEIPT (Idaho State University) form is 1 page long and contains:

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  • 3 check-boxes
  • 16 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Idaho State University

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Payment Method: □ Cash □ Travel Card □ Personal Card
Claimant Name:
Expense Report:
Vendor Name:
City: Phone #:
Date(s) of receipt(s):
Lost Receipt #1: Amount: $
Lost Receipt #2: Amount: $
Total Amount: $
Description of Expense(s):
I certify while on official university business, I incurred the above expense(s) as described.
I have lost, misplaced, or did not receive receipt documentation from the vendor.
I certify that this is a proper charge that I have not previously requested, nor will again in
future requests for reimbursement.
Claimant Signature:
Revised 3/1/2018
This form may not be used in lieu of receipts that may be obtained as duplicates from vendors.
Idaho State University
Affidavit of Lost Receipt
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AFFIDAVIT OF LOST RECEIPT (Idaho State University)

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Completed 24 July 2020

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