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CITY OF LA PORT <br />P-CARD � <br />LOST RECEIPTS FORM A <br />rexo <br />} D� n <br />do hereby certify that the receipt was lost <br />and a replacement could not be obtained for the- following item: <br />Vendor Y 1 I ya <br />Description r� <br />Doiiar Amount $ U <br />These items were for the City of La Porte and are legitimate charges made by my Department and <br />should be charged to the following account number: <br />0.3 <br />Employee Signature: <br />Print Employee Name: <br />Date: MA <br />� <br />Department Director Approval: <br />(Required) <br />I <br />