Osf Form 20a Request For Replacement Of A Missing Warrant Canceled By Statute
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1OSF Form 20A
STATE OF OKLAHOMA
(Revised 3/00)
REQUEST FOR REPLACEMENT OF A MISSING
WARRANT CANCELED BY STATUTE
Date _____________
PART I - Paying Agency Use
Request a replacement warrant be issued for the following warrant which has canceled pursuant to the
provisions of Title 62, Section 41.19, Oklahoma Statutes. Said replacement warrant is owing the named payee
or holder in due course in the amount specified, not to exceed the original warrant, and for the purpose certified
in the original claim filed with the Office of State Finance by the paying agency.
I hereby certify that to the best of my knowledge the information in Part I and Part II is true and factual.
___________________________
____________________________
Agency Approving Officer
Title or Position
Agency No.
*********************************************************************************
PART II - Payment Information
Warrant
Issue
Payee / Holder In Due Course
Fund - Agency - Account
Number
Date
Claim No.
Invoice No.(s)
Payee / Holder In Due Course:
if completing this form, provide as much of Part II as known, with a minimum of
Warrant Number, Issue Date and Payee / Holder In Due Course.
Paying Agency:
.
complete the remainder of information in Part II
*********************************************************************************
PART III -
PAYEE / HOLDER IN DUE COURSE
AFFIDAVIT OF LOST
STATUTORY CANCELED WARRANT
I, ___________________________ , being duly sworn according to law, depose and say that the above listed
warrant was canceled by statute before said warrant was presented for payment. The warrant in the amount of
$ ____________ is now missing and will not subsequently be presented for payment by the payee / holder in
due course. In consideration of the issuance of a replacement warrant, the undersigned payee / holder in due
course, agrees to indemnify and protect the State of Oklahoma from any loss or harm arising from the issuance
of such replacement warrant
____________________________
________________ _________________________________
Payee / Holder In Due Course
Title or Position
Business Name
State of _________________________
County of _______________________
Subscribed and sworn before me
My Commission expires
,
.
(Notary Public or Clerk
or Judge)
Instructions: If
the original warrant is not available, payee / holder in due course must complete Part III and
appropriate information in Part II of this form. The paying agency must complete Part I and appropriate
information in Part II. NOTE: If the original warrant is available, use OSF Form 20, instead of this form.
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