Hibbing Public Utilities 

Affidavit of Lost or Missing Receipt

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Affidavit of Lost or Missing Receipt
Form of Payment
Clear Signature
Certification | While on official business I incurred the expense described above. I hate lost, misplaced or did not receive the receipt documenting payment. I am submitting this affidavit in lieu of the missing receipt. I certify that this is a proper charge for a cost incurred while on official business and that I have not previously requested, nor will I again request reimbursement for this expense.
Clear Signature
Manager Name
Date / Time

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