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 _________________________________
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Rev. 10/04 5.11a