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APPLICATION FOR DUPLICATE INSTRUMENT AFFIDAVIT <br />(RCW 43.08) <br />Requirements Before Issuance of Duplicate Instruments <br />Before a duplicate instrument is issued the issuing officer shall require the person making application for its <br />issue to file in his office a written affidavit specifically alleging on oath that he is the proper owner, payee, <br />or legal representative of such owner or payee of the original instrument, giving the date of issue, the <br />number, amount, and for what services of claim or purpose the original instrument or series of instruments <br />of which it is a part was issued, and that the same has been lost or destroyed, and has not been paid. <br />AFFIDAVIT <br />STATE OF WASHINGTON, ) SS, <br />COUNTY OF KITTITAS ) <br />Kittitas Co Fire District #1, being first duly sworn upon oath, depose and say that I am the <br />proper owner, payee, or legal representative of such owner or payee of Kittitas County original <br />check number 351409963 dated 7/23/2025, in the amount of Two Thousand Eight Hundred <br />Thirteen Dollars and Sixty Five cents ($2813.65.) of which said instrument, payable to <br />Kittitas Co Fire District #1, was issued in payment for services or wages and that the same has <br />been lost or destroyed and has not been cashed. <br />Sign Her' �. �`�ww�, title <br />State, Zip <br />Subscribed and sworn to before me this day of 120 <br />Notary Public in and for the State of Washington, <br />Residing at <br />If the lost warrant is found, it needs to be returned to the Auditor's office and if the <br />warrant is cashed you are responsible for reimbursement to the County as this <br />becomes a duplicate payment. <br />Vendor Number Date Reissue New Warrant # <br />