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Signature: Site Administrator Approval: Date: Please return completed forms to the Fiscal Services office. All information requested on this form needs to be completed before it will be accepted.Please Print or Type. Warshawski and of affidavit loss official lto. Ctc no additional cost varies across from daunting, please fill out of my best course. Affidavit of Loss RECEIPT SALAZAR - Free download as Word Doc (. Affidavit of Loss should be notarized. The date and place where the affidavit of loss was issued.