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Missing Receipt Form
FY
Use this form when a receipt has been lost or was never available. This form, when completed and signed,
functions as your receipt. Attach to other forms as needed. Last update 7/27/2015 SBeaver. Note: You must
select a relevant fiscal year from the drop-down box in the top right corner of this form.
Employee or Cardholder Name
Purchase Type:
PO Number (if applicable)
Messiah Purchasing Card (M&T)
Organization (Org #)
Cash Advance
Requisition / Purchase Order
Account (Acct #)
Personal Cash / Personal Credit Card
Activity Code (if applicable)
Reason for Missing Receipt:
Purchase Amount
Receipt has been lost
Receipt was never provided
Purchase Date
Other (please provide explanation below)
Other Reason:
What was
purchased?
Where was the
purchase
made?
Why was the
purchase
made?
**Note: All expenditures must meet the criteria outlined in the Expenditure Policy in order to be paid using College funds.
I certify that I have examined this request and that all expenses meet those outlined in Messiah College's expenditure policy and
purchasing policies.
Employee/Cardholder
Printed Name
Signature
Date
Printed Name
Signature
Date
Supervisor / VP