AFFIDAVIT TO OBTAIN DUPLICATE OF LOST OR DESTROYED WARRANT
STATE OF CALIFORNIA
COUNTY OF SANTA BARBARA
SS
___________________________________________; being duly sworn, says: That
he/she is the said legal owner of that certain county warrant numbered __ __ - __ __ __ __ __ __,
dated __ __ /__ __/ 2 0 __ __, and drawn by the county auditor of the County of Santa Barbara,
on the GENERAL FUND School District Fund (fund number 9610) of said County, in favor
of _________________________________________________________ as payee thereof, for
_____________________________________________________ dollars ($__________.____);
That said warrant has not been paid but was lost / destroyed before the same was paid by the
county treasurer of said County of Santa Barbara and cannot now be produced by the said legal
owner.
That the circumstances of such loss and all material facts relative thereto, are as follows:
I understand that if I receive the above warrant I agree not to cash the warrant but instead to
return the said warrant to district.
Signature of Payee Date signed
Printed name of Payee Phone number of Payee
District Authorized Contact District phone number
721 Cliff Drive, Santa Barbara, CA 93109
Originate by _____________________ Date __________
Student K number _____________________
Check FINN _____________________ Date __________
Sent to Accountant _____________________ Date __________
Process by Accountant _____________________ Date __________
click to sign
signature
click to edit
![]()
