ࡱ> BDAg "bjbjVV .$r<r< ....J.<#t^B{-P"""""""$$b'"E}{{}}""}}}}"}}"}}V!@W"Pw! w" #0<#!x'w'W"'W" }}}}}}}}""}}}}<#}}}}'}}}}}}}}} : AFFIDAVIT OF FORGERY form Instructions: Report all forgeries to Cash Management ASAP at (907) 474-6497. Endorsement statute of limitations = 3 years; signatures = 60 days upon receipt of statement. Fill out the form according to the instructions. Help is available when you click on each form area. The help and instructions are available in the status line towards the bottom of your screen. This form is NOT designed to be printed and then filled in; it must be filled in using MS Word. The Notary area must be filled out and signed once the form is complete and printed. Following must be provided to Cash Management: An original complete Affidavit of Forgery form. Payee/requestor MUST take the Affidavit of Forgery and report it to the campus or local police department and a case number MUST be obtained (the bank will not process without a case number). Write the case number on the Affidavit of Forgery form. A copy of the written statement provided to the police (this speeds up the banks processing time); however, an informal written statement of entire scenario will suffice. All information must be submitted to Cash Management. Cash Management will work closely with the bank to recover the funds. The campus may use their discretion to issue a new check before the University recovers the funds, but there is the risk of loss to the department/campus should the original funds not be recovered. Special note: The campus/department should always obtain sufficient contact numbers and addresses from the payee/requestor. Correct and current information on file provides immediate access should the person challenging the forged check need to be contacted for ANY reason. CM FILE NOTE: A clear legible copy (original preferred) of the check must accompany the Affidavit of Forgery sent to the bank and a courtesy report to Internal Audit. AFFIDAVIT OF FORGERY STATE OF ALASKA ) ) ss. Case No. _________________ THIRD JUDICIAL DISTRICT ) I,  FORMTEXT      , of the City of  FORMTEXT      , State of Alaska, residing at  FORMTEXT       being duly sworn, deposes and says that a certain check number  FORMTEXT      , dated  FORMTEXT       on  FORMTEXT      ,  FORMTEXT       Branch in favor of  FORMTEXT       in the amount of $ FORMTEXT       and endorsed by  FORMTEXT       and purporting to be  FORMDROPDOWN  by  FORMTEXT       and paid by  FORMTEXT       on the  FORMTEXT       day of  FORMTEXT      ,  FORMDROPDOWN , was not  FORMDROPDOWN  by me, and that this signature on said check is a forgery. I further state that I did not authorize the  FORMDROPDOWN  of said check, and that no part of the money so paid by the  FORMTEXT       was receive(+ PShj  .0DFHRT8:NPR\^npո߫ոߞոߑո߄ոjhm1CJUjhm1CJUjhm1CJUj0hm1CJUjhm1CJUmHnHujhm1CJUjhm1CJU hm1CJ hm1CJhm15CJ\hm1 hm1>*CJ/*+k F G v w L M PQRhij}$a$ & Fp q !!!!!!!!/"0"1"2"a""""""dh*,.8:`bvxz$&:<>HJdfzҸҫҞґ҄j hm1CJUj hm1CJUjhm1CJUjhm1CJUjhm1CJUjhm1CJU hm1CJjhm1CJUmHnHujhm1CJUjhm1CJU/z|~02NPR&(DFH "ҸҫҞґ҄҂Ujhm1CJUjhm1CJUjhm1CJUjHhm1CJUjhm1CJUjhm1CJU hm1CJjhm1CJUmHnHujhm1CJUj hm1CJU+d by me, directly or indirectly, and that no part of said money was applied to any use or purpose in my behalf. I further state that I will testify, declare, and depose or certify to the truth of any or all of the foregoing before any competent court, officer, or person in any case now pending or that may be hereafter instituted in connection with the matter contained in this affidavit. _____________________________________ (Signature of Payee/Requestor) Subscribed and sworn to before me on this _____ day of ________________, 20___. _________________________________________ Peace Officer or Notary Public in and for the State of ֱֻ My Commission Expires: __________________ ,1h/ =!"#$% 0DText1^Enter the name of the person claiming the item is forged - payee or requestor (if a business).DText2*Enter Payee/Requestor's city of residence.DText3 Enter Payee/Requestor's address.D Text4?Enter the full check number of forged item (Example: H1004263).DText5EEnter the date of the forged item (located on the face of the check).DText6HEnter the name of the drawee bank (Example: First National Bank Alaska).DText7=Enter the Branch of the drawee bank (Example: Golden Valley).`DText8vEnter the Payee on the forged item. For a Business account the AUTHORIZED SIGNER enters their name and business name.D Text9$Enter the amount of the forged item.dDText10wEnter the name of the forger. If unknown or illegible, write "unknown." If no endorsement is available, write "blank."Df Dropdown1tUse the drop-down menu to choose 'signed' (maker of the check) or 'endorsed' (endorsement on the back of the check).signedendorsedVDText11pEnter Payee/Requestor's name. If a business, the Authorized Signer will enter their name and the business name.&DText12XEnter name of drawee bank (always the name of the bank listed on the face of the check.)zDText13Enter the date the check was paid. Call Cash Management for the final date, or obtain the information from the back of the check.DText14#Enter the month the check was paid.Df Dropdown2200120022003Df Dropdown3<Choose from dropdown menu: Issued= maker Endorsed = payeeendorsedissuedDf Dropdown4issuance endorsement6DText16`Drawee bank of forged check. 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N-                           m1 @@ X@XXXX@@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial?= *Cx Courier New;WingdingsACambria Math"1h"'"'xsb    !20 JQHP  $P2!xx Affidavit of Forgery Linda CookBrittany D. Hoch   Oh+'0d    , 8DLT\Affidavit of Forgery Linda CookNormalBrittany D. Hoch2Microsoft Office Word@@)Ū@@  ՜.+,0  hp  Financial Services  Affidavit of Forgery Title  !"#$%&'()*+,-./02345678:;<=>?@CRoot Entry FEData 1Table(WordDocument.$SummaryInformation(1DocumentSummaryInformation89CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q