Affidavit For Duplicate State Warrant Form
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1DEPARTMENT OF FINANCE AND ADMINISTRATION
FINANCIAL CONTROL DIVISION
STATEWIDE, HUMAN RESOURCES, ACCOUNTING AND
MANAGEMENT REPORTING SYSTEM (SHARE)
AFFIDAVIT FOR DUPLICATE STATE WARRANT
As provided in Section 6-10-60 (A), NMSA 1978,
(Party Applying for Duplicate Warrant)
being duly sworn according to law, deposes and says that Original Warrant Number
A or B or D (Circle One)
dated
was issued by
on Payment Voucher Number(s)
(Name of State Agency)
to
in the amount of $
(Party Applying for Duplicate Warrant)
The affiant further states that he/she never received any benefit from or any value of said warrant or any part
thereof; that the original warrant has been lost or was never received; and that he/she did not present this warrant for
negotiation or payment. The affiant further agrees that any and all original warrants subsequently found or received
will be returned to:
New Mexico Department of Finance and Administration/ Financial Control Division,
407 Galisteo Bataan Memorial Building Rm. 166
Santa Fe, New Mexico 87501
(Signature of Party Applying for Duplicate Warrant)
(Date)
(Printed Name)
(Title)
State of____________________
County of __________________<- ss.
known to me to be the persons described in
On this________day of_________________, 20_____,
and who executed the above and foregoing instrument and acknowledged to me that they executed
the same as their free act and deed.
___________________________________________________________________ My commission expires:____________
(Notary Public)
DO NOT WRITE BELOW THIS LINE (FOR DFA/FCD USE ONLY)
I certify this is a true and exact copy of the original affidavit for duplicate state warrant and the original warrant has not
cleared the Treasury of the State and a Stop Payment has been filed with the Treasury.
Stop Pay#
_____________________________
________________________________________
Stop Pay Dated
_______________________
(Signature of DFA employee)
(Date)
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