Skip to Main Content
Loading
Loading
Search
Your Government
For Residents
For Visitors
Doing Business
I Want To
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
ACAC
Anacortes Museum
City Council
Fiber
Finance
Human Resources
Legal Department
Library
Municipal Court
Office of the Mayor
Parks and Recreation
Planning
Planning
Police
PW Engineering
PW Operations
PW Stormwater
PW WTP
PW WWTP
Report A Concern
Safety Committee
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Affidavit of Lost or Destroyed Receipt - PCard
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Affidavit of Lost of Destroyed Receipt - PCard
Employee Name:
*
Department:
*
Last 4 Digits of Card Number:
*
I understand that falsification of the itemization of this purchase constitutes an act of fraud:
I declare on oath that the original receipt(s) in the below itemized listing has been lost or destroyed. The vendor has been contacted and is not able to provide a duplicate receipt for this purchase.
Item Purchased (details, please)
Amount of Item
Item Purchased (details, please)
Amount of Item
Item Purchased (details, please)
Amount of Item
Electronic Signature Agreement
*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
*
Date:
*
Date:
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
* indicates a required field
Library
Parks & Recreation
Utility Services
Permits
Meetings
Access - Fiber Internet
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow