Lost or Stolen Check Form - California Department of Food and Agriculture

LOST OR STOLEN CHECK FORM Form 1.2.9. (05.2019) State of California California Department of Food and Agriculture Office of Grants Administration

LOST/ STOLEN CHECK BOOKLET FORM

When reporting lost or stolen checks, the AAA must:

1. Complete the Lost/Stolen Check Booklet Form and send to CDFA. 2. Document the lost/stolen check(s) on the Check Control Log that are lost/stolen. 3. Document the lost/stolen check(s) on the original Check Issuance Form.

REPORTING AGENCY INFORMATION: AAA (PSA _____) Name of Agency completing report: ____________________________

AAA Staff Reporting: _____________________ Phone Number: ____________________

MISSING CHECK(S)/ BOOKLET INFORMATION: Sequence numbers of missing SFMNP Check(s) or booklets:

Date discovered missing: ________________

Beginning Check Number: _______________ Ending Check Number: _______________

Person Reporting Missing Check(s): __________________________________________

COMMENTS: Briefly describe the situation on how the SFMNP check(s)/ booklets were lost, or stolen:

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*Please note CDFA cannot replace lost or stolen checks/booklets.

PLEASE EMAIL COMPLETED FORM TO grants@cdfa. WITHIN FIFTEEN (15) CALENDAR DAYS OF NOTIFICATION

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