Missing Receipt Affidavit

Missing Receipt Affidavit
Employee Name

First NameLast Name
Date of Purchase

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Business / Vendor Name
Purchase Amount
Job Number / Truck Number / Overhead
Reason Receipt Is Missing
Business Purpose of Transaction
I understand that a Missing Receipt Affidavit should be used only when a receipt is lost or otherwise unavailable and reasonable efforts to obtain a replacement have been exhausted. I certify that the information provided above is accurate, the expense was incurred for a legitimate Ozone Environmental Service business purpose, the amount shown is the amount actually paid, and I have not and will not submit a duplicate claim for this expense.
I certify that the information above is true and correct.
Signature
Should be Empty: