Rev. 08/03

Section 5.11

Page 1 of 1

SECTION 5.11 – LOST PAYROLL WARRANTS

Contact: Payroll @ Extension 4160

A.

Overview

If a payroll warrant is lost by the postal service or misplaced by the

employee:

z

It can take up to 5 days before a reissue can occur for the lost

warrant.

z

Payroll coordinates with the Snohomish County Treasurer’s Office

to determine if the warrant has been redeemed before a reversal is

run and a reissue is processed.

z

The APPLICATION FOR DUPLICATE WARRANT AFFIDAVIT

must be signed by the employee before a reissued warrant can be

processed.

z

All employees, including substitutes, are encouraged to use the

direct deposit system.

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Rev. 10/04

5.11a

APPLICATION FOR DUPLICATE WARRANT AFFIDAVIT

(RCW 39.72 AND RCW 43.08)

REQUIREMENTS BEFORE ISSUANCE OF DUPLICATE INSTRUMENTS

Before a duplicate instrument is issued, the issuing officer shall require the person making application

for its issue to file in his office a written affidavit specifically alleging on oath that he is the proper

owner, payee, or legal representative of such owner or payee of the original instrument, giving the date

of issue, the number, the amount, and for what services or claim or purpose the original instrument or

series of instruments of which it is a part was issued, and that the same has been lost or destroyed, and

has not been paid.

AFFIDAVIT

STATE OF WASHINGTON)

SS

COUNTY OF SNOHOMISH)

I, ______________________ being first duly sworn on oath, depose and say: that I am

the proper owner, payee, or legal representative of such owner or payee of the

EVERETT

SCHOOL DISTRICT, NO. 2

original warrant No. _______, dated _______________, in the total

amount of _____________________

DOLLARS ($_____) which said instrument was issued in

payment for _______________________

and that the same has been lost or destroyed and has

not been paid.

__________________________________

SUBSCRIBED AND SWORN BEFORE ME THIS ______ day of _________________, 20__.

________________________________________________

NOTARY PUBLIC in and for the State of

Washington, residing at _____________________________

DUPLICATE WARRANT ISSUED ON _________________________________