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Click ‘Get Form’ to open the Lost Evidence Form in our editor.
Begin by entering your name in the 'Name of Declarant' field at the top of the form.
In section 1, provide details about the disbursement: enter the date, amount paid, vendor name, vendor address, and a brief description of the supplies or services purchased.
Next, specify the purpose for which these supplies or services were purchased in the designated field.
In section 2, describe how you lost the receipt that serves as evidence of payment. Be as detailed as possible.
Finally, sign and date the form at the bottom. Ensure your mailing address is filled out correctly and include your supervisor's signature and printed information.
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declaration of missing evidence that a payment was
DECLARATION OF MISSING EVIDENCE THAT A PAYMENT WAS MADE ON BEHALF. OF THE REGENTS OF THE UNIVERSITY OF CALIFORNIA. Submit this form, completed by payee
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