Seattle University
Office of the Controller
901 12th ave
Seattle, WA 98122
Tel :(206)296-5880
Fax:(206)296-5896
Seattle University
Affidavit of Lost or Destroyed Check
Today's Date:
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I, __________________________, having been duly sworn, depose, and say that I am the proper owner,
payee, or legal representative of Seattle University's check no. _______, dated ________, in the amount
of __________ dollars, and that said check has been lost, destroyed, or not delivered to me, and to the
best of my knowledge has not been paid.
I further affirm that if said check is later found by me, I will return the check to Seattle University.
SU ID #
Printed Name:
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Signature:
________________________________
Address:
Please return this form to the Controller's Office. Allow a minimum of 5 working days to process