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MISSING&FUEL&RECEIPT&AFFIDAVIT& This&form&is¬&a&substitute&for&an&original&rec e ipt&and&should&only&be&used&when&all&attempts&to&obtain&an original&receipt&have&failed. Repeat&cases&of&missing&receipts&can&be&grounds&for&account&suspension&or&permanent&deactivation.& Purchases&without&receipt&detail&may&be&considered&personal&purchases&if&the&department&or&university&is&unable&to& (Boise State University)

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The MISSING&FUEL&RECEIPT&AFFIDAVIT& This&form&is¬&a&substitute&for&an&original&rec e ipt&and&should&only&be&used&when&all&attempts&to&obtain&an original&receipt&have&failed. Repeat&cases&of&missing&rec form is 1 page long and contains:

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Rev 07/2015
MISSING&FUEL&RECEIPT&AFFIDAVIT&
This&form&is&not&a&substitute&for&an&original&rec e ipt&and&should&only&be&used&when&all&attempts&to&obtain&an
original&receipt&have&failed.
Repeat&cases&of&missing&receipts&can&be&grounds&for&account&suspension&or&permanent&deactivation.&
Purchases&without&receipt&detail&may&be&considered&“personal”&purchases&if&the&department&or&university&is&unable&to&
determine&what&was&purchased&and&the&business&purpose&of&the&purchase.&&
Employee&Name&& &Department&&
Merchant&Name&
&Transaction&Date&
&&&Amount:&
_______________________________& $______________________&
________________________________&$______________________&
________________________________________&$______________________&
________________________________&$______________________&
_______________________________________& $______________________&
Item(s)&Purchased:&
______________&
_____________&
_____&
_____________&
______& &
______& &
_______________________________________& $______________________&
Total:&
$______________________&
Business&Purpose&of&
Purchase:
I&certify&the&purchase&noted&above&was&a&necessary&and&legitimate&business&expense.&I am&unable&to&provide&the&original&
or&duplicate&receipt&due&to:&(please&explain&why&you&do not&have&the&original&or&cannot&obtain&
a duplicate&receipt)&
Employee&Signature&
&Date&
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MISSING&FUEL&RECEIPT&AFFIDAVIT& This&form&is¬&a&substitute&for&an&original&rec e ipt&and&should&only&be&used&when&all&attempts&to&obtain&an original&receipt&have&failed. Repeat&cases&of&missing&receipts&can&be&grounds&for&account&suspension&or&permanen

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Completed 22 July 2020

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