Summary: UNIVERSITY OF CALIFORNIA, SANTA BARBARA
BERKELEY · DAVIS · IRVINE · LOS ANGELES · MERCED · RIVERSIDE · SAN DIEGO · SAN FRANCISCO SANTA BARBARA · SANTA CRUZ
ACCOUNTING SERVICES & CONTROLS SANTA BARBARA, CALIFORNIA 93106-2040
DECLARATION OF MISSING EVIDENCE THAT A PAYMENT WAS MADE ON BEHALF
OF THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Submit this form, completed by the traveler along with the Travel Expense Vouchers form, when
original required receipt(s) have been lost or misplaced by the traveler. Fax copies or
photocopies of lost or unavailable receipts must accompany this form. This form is in no way
intended as a replacement for no receipt documentation or to serve as evidence of incurred
Please have traveler complete one form per receipt. Attach form(s) to Travel Expense Voucher.
Copy this form as needed.
_______________________________ declare that:
(Traveler's Name Please Print)
1. Circle applicable option:
a. I disbursed personal monies on behalf of the Regents of the University of California
b. University funds were disbursed on my behalf by the Regents of the University of