SNOHOMISH COUNTY, WASHINGTON
Department of Budget and Finance
AFFIDAVIT FOR LOST/DESTROYED WARRANT
STATE OF WASHINGTON ) ss,
County of Snohomish )
I, ___________________________________________, upon oath, depose and
say that I am the proper owner, payee, or legal representative of such owner or
payee of Snohomish County
original (claims/salaries) warrant NO. _____________________
dated _____________________ in the amount of $__________________________
which said warrant instrument was issued and that the same has been lost or destroyed
and has not been paid.
I certify under penalty of perjury under the laws of the State of
Washington that the foregoing is true and correct.
G:/finance/payroll/forms/Lost Warrant blank.doc 07/27/2012