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“Improving Our Quality of Life” Date: Cardholder Name: Cardholder Number: Vendor Name: Items Purchased (detailed): Acct $ Acct $ Acct $ Reason for no receipt: Affidavit and Receiving Report I certify under penalty of perjury that the within bill is just and correct, and that neither the whole nor any part thereof has been paid by the City of Laramie, or by any individual. I certify that the material or services have been received and the account is approved for payment. Procurement Card Generic Voucher Request