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No information is available for this page. I am submitting this affidavit requesting that the clerk of the court of.County, Nebraska issue a new check replacing the previously mentioned check. This form is also known as the Declaration of Lost or Destroyed Payroll Check and is used to replace a lost, damaged or stale dated paycheck. With this affidavit I am requesting that Seattle University place a Stop Payment on the above- described check and reissue a replacement check. (Complete fillable form, print, sign, notarize and mail to address shown above). Hyer Hall 104 • 800 West Main Street • Whitewater, WI 53190-1790 • Phone 262-472-1378. Therefore, I make this affidavit to induce the issuance of a duplicate check in the above said amount. To Submit: Scan the completed Replacement Check Affidavit form and login to my.FIU.edu. Click on "Student Tools" tile then "Document Upload".