Missing Receipt Documentation - The University Of West Georgia

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Office of the Controller
Carrollton, Georgia 30118-4220
Division of Business and Finance
MISSING RECEIPT DOCUMENTATION
Check One:
Procurement Card
Reimbursement
Travel
Vendor Name: ________________________________________________________________________________________
Amount: _____________________________________________________________________________________________
Date Purchased: _______________________________________________________________________________________
Items Purchased:
Purpose of Purchase:
Please explain the circumstances resulting in the missing receipt:
Please explain the action taken to obtain a duplicate receipt from the vendor:
Please attach official documentation which certifies the transaction occurred (for example: credit card/debit card statement,
cancelled check, etc).
I certify and attest that the above statements are true and I have incurred the described expenses. I further certify that these
expenses were for official University purposes. I also have read and understand the University’s policy requiring original
receipts for reimbursement requests. This policy can be found at
_________________________
__________________________________________
_________________________
Print Name
Signature of Purchaser
Date
_________________________
__________________________________________
_________________________
Print Name
Supervisor/Department Head Signature
Date
__________________________________________
____________________________
Business & Finance Approval
Date

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