HomeMy WebLinkAbout2025-07-23 - $2,813.65 - Void ApprovalAPPLICATION FOR DUPLICATE INSTRUMENT AFFIDAVIT
(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, amount, and for what services of 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 KITTITAS )
Kittitas Co Fire District #1, being first duly sworn upon oath, depose and say that I am the
proper owner, payee, or legal representative of such owner or payee of Kittitas County original
check number 351409963 dated 7/23/2025, in the amount of Two Thousand Eight Hundred
Thirteen Dollars and Sixty Five cents ($2813.65.) of which said instrument, payable to
Kittitas Co Fire District #1, was issued in payment for services or wages and that the same has
been lost or destroyed and has not been cashed.
Sign Her' �. �`�ww�, title
State, Zip
Subscribed and sworn to before me this day of 120
Notary Public in and for the State of Washington,
Residing at
If the lost warrant is found, it needs to be returned to the Auditor's office and if the
warrant is cashed you are responsible for reimbursement to the County as this
becomes a duplicate payment.
Vendor Number Date Reissue New Warrant #
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Transaction Detail
Kittitas County Treasurer
SinglePoint
Printed on 07/29/2025 at 02:52 PM PDT
Transaction Detail for 07/25/2025
Account CCY Amount Transaction Description
Kittitas County - Payroll/153607389480 USD $2,813.65 Miscellaneous Credit(s)
Check 351409963 Refer to Maker SPT Return
Bank Reference: PFSGPTWEST0725020056
Transaction Reference: 0351409963
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