LOST/MISSING RECEIPT DECLARATION
LOST/MISSING RECEIPT DECLARATION
Purpose of Form
This form is to be used on rare occasions when claimants have lost or misplaced their original receipts. Each claimant must certify that an expense receipt was lost accidentally, destroyed or unobtainable. This Declaration Form must be attached to the claim being submitted.
Declaration
I, ____________________________, hereby declare the following receipt(s) has been lost or misplaced:
________________________________________________________________________
I further declare that I have not and will not use this missing receipt to claim reimbursement from any other source, or to support any claim for income tax deductions in the future.
Claimant
_______________________________
PRINT NAME
_______________________________
SIGNATURE
Approval
_______________________________
WDD DEPUTY DIRECTOR
................
................
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