Form STD435 "Request for Duplicate Controller's Warrant/Stop Payment" - California (English/Spanish)

What Is Form STD435?

This is a legal form that was released by the California Department of General Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the California Department of General Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form STD435 by clicking the link below or browse more documents and templates provided by the California Department of General Services.

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Download Form STD435 "Request for Duplicate Controller's Warrant/Stop Payment" - California (English/Spanish)

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STATE OF CALIFORNIA - CONTROLLER’S OFFICE
REQUEST FOR DUPLICATE CONTROLLER’S WARRANT / STOP PAYMENT
STD 435 (Rev. 10/2019) Page
1
DATE REQUESTED
AGENCY TELEPHONE NUMBER
WARRANT NUMBER
REQUESTING AGENCY
UNIT / SECTION
DATE ISSUED (MM-DD-YY)
IDENTIFICATION NUMBER
AMOUNT (Net Only)
NAME (Exactly as it appears on warrant)
FUND NUMBER
SCO USE ONLY
NAME
STATUS
EFFECTIVE STOP DATE
ADDRESS
REPLACEMENT NUMBER
AND ZIP CODE
REPLACEMENT DATE
RETURN TO:
State Controller's Office, Administration and Disbursements Division - Post Issuance Unit
P.O. Box 942850, Sacramento, California 94250-5871
IMPORTANT! SEE INSTRUCTIONS (on Page 2)
I,
Mailing
Address:
STREET
CITY
STATE
ZIP CODE
certify or declare:
That the State of California Controller’s warrant described above was
never received;
lost/destroyed;
(give date, including year), under the following circumstances:
stolen on or about
That declarant is the owner or custodian of said warrant, has not cashed or transferred same, and is entitled to possession
thereof; or the corporation, partnership, or government agency in whose behalf declarant makes this application, is the
owner or custodian, has not cashed or transferred same, and is entitled to possession thereof.
(If a corporation is owner or custodian) That declarant is an officer, to wit
TITLE
of,
, a corporation and is authorized to make this
application and enter into the indemnity agreement provided herein on behalf of said corporation.
Application is made to the State Controller to issue a duplicate warrant in lieu of said original warrant, and declarant, or
partnership or corporation in whose behalf he applies, agrees to indemnify and hold harmless the State, its officers and
employees, from any loss resulting from the issuance of said duplicate warrant. (This indemnity agreement is not applicable
if the payee of the lost or destroyed warrant is any governmental agency or officer thereof; or if the State of California, agency
or officer thereof, is owner or custodian.)
I/We certify (or declare) under penalty of perjury that the foregoing is true and correct.
SIGNATURE OF DECLARANT(S)
DATE SIGNED
1.
DATE SIGNED
2.
TITLE (If signing for Corporation, Partnership or Government agency)
CORPORATION, PARTNERSHIP OR GOVERNMENT AGENCY NAME (If applicable)
DAYTIME TELEPHONE NUMBER (Include Area Code)
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STATE OF CALIFORNIA - CONTROLLER’S OFFICE
REQUEST FOR DUPLICATE CONTROLLER’S WARRANT / STOP PAYMENT
STD 435 (Rev. 10/2019) Page
1
DATE REQUESTED
AGENCY TELEPHONE NUMBER
WARRANT NUMBER
REQUESTING AGENCY
UNIT / SECTION
DATE ISSUED (MM-DD-YY)
IDENTIFICATION NUMBER
AMOUNT (Net Only)
NAME (Exactly as it appears on warrant)
FUND NUMBER
SCO USE ONLY
NAME
STATUS
EFFECTIVE STOP DATE
ADDRESS
REPLACEMENT NUMBER
AND ZIP CODE
REPLACEMENT DATE
RETURN TO:
State Controller's Office, Administration and Disbursements Division - Post Issuance Unit
P.O. Box 942850, Sacramento, California 94250-5871
IMPORTANT! SEE INSTRUCTIONS (on Page 2)
I,
Mailing
Address:
STREET
CITY
STATE
ZIP CODE
certify or declare:
That the State of California Controller’s warrant described above was
never received;
lost/destroyed;
(give date, including year), under the following circumstances:
stolen on or about
That declarant is the owner or custodian of said warrant, has not cashed or transferred same, and is entitled to possession
thereof; or the corporation, partnership, or government agency in whose behalf declarant makes this application, is the
owner or custodian, has not cashed or transferred same, and is entitled to possession thereof.
(If a corporation is owner or custodian) That declarant is an officer, to wit
TITLE
of,
, a corporation and is authorized to make this
application and enter into the indemnity agreement provided herein on behalf of said corporation.
Application is made to the State Controller to issue a duplicate warrant in lieu of said original warrant, and declarant, or
partnership or corporation in whose behalf he applies, agrees to indemnify and hold harmless the State, its officers and
employees, from any loss resulting from the issuance of said duplicate warrant. (This indemnity agreement is not applicable
if the payee of the lost or destroyed warrant is any governmental agency or officer thereof; or if the State of California, agency
or officer thereof, is owner or custodian.)
I/We certify (or declare) under penalty of perjury that the foregoing is true and correct.
SIGNATURE OF DECLARANT(S)
DATE SIGNED
1.
DATE SIGNED
2.
TITLE (If signing for Corporation, Partnership or Government agency)
CORPORATION, PARTNERSHIP OR GOVERNMENT AGENCY NAME (If applicable)
DAYTIME TELEPHONE NUMBER (Include Area Code)
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STATE OF CALIFORNIA - CONTROLLER’S OFFICE
REQUEST FOR DUPLICATE CONTROLLER’S WARRANT / STOP PAYMENT
STD 435 (Rev. 10/2019) Page
2
INSTRUCTIONS
1.
The completion of this application will enable the State Controller to send you a duplicate warrant to
replace the original which was reported as never received, lost/destroyed, or stolen. If you receive the
original warrant prior to completing this application: cash the original warrant and destroy this
application.
2.
IMPORTANT: For your records, please make a copy of Page 1 or note the warrant number, date issued, amount,
and agency telephone number.
3.
Inquiries can be made to the requesting agency. See top of Page 1, AGENCY TELEPHONE NUMBER.
4.
Please fill out the application carefully and completely. All blanks must be filled. An individual applying in
his/her own behalf need not show his/her title, or name of firm, corporation, or governmental agency. If
the warrant is drawn to more than one payee, each must sign the application exactly as the name appeared
on the original warrant. See Page 1, NAME (Exactly as it appears on warrant).
5.
Once the application has been signed and returned to the State Controller's Office, DO NOT CASH THE
ORIGINAL WARRANT. If the original warrant is presented for payment, it will not clear through the banking
system, and processing charges may result. The original warrant is invalid. Please destroy if received or recovered.
6.
After completion, mail all original pages to:
State Controller's Office
Administration and Disbursements Division - Post Issuance Unit
P.O. Box 942850
Sacramento, CA 94250-5871
INSTRUCCIONES
1.
El completo de esta solicitud permitirá al Controlador del Estado del Estado enviarle un cheque duplicado para
substituir el original que fue reportado como nunca recibido, perdido/destruido, o robado. Si usted recibe el
cheque original antes de llenar esta solicitud: cobre el cheque original y destruya esta solicitud.
2.
IMPORTANTE: Para su expediente, por favor haga una copia de página 1 (Page 1) o anote el número del cheque
(WARRANT NUMBER), fecha (DATE ISSUED), cantidad (AMOUNT), y número de teléfono de la agencia (AGENCY
TELEPHONE NUMBER).
3.
Preguntas se pueden dirigir a la agencia. Vea parte superior de Page 1, AGENCY TELEPHONE NUMBER.
4.
Por favor complete la solicitud cuidadosamente y totalmente. Todos los espacios en blanco deben ser llenados. Si
el beneficiario aplica por si mismo, no necesita demostrar su título, el nombre de la corporación, o de la agencia
gubernamental. Si el cheque esta a nombre de más de un beneficiario, cada uno debe firmar la solicitud
exactamente como apareció el nombre en el cheque original. Vea Page 1, NAME (Exactly as it appears on warrant).
Una vez que la solicitud a sido firmada y regresada a State Controller's Office, NO COBRE EL CHEQUE ORIGINAL.
5.
Si el cheque original es presentado por pago, no sera pagado a través del sistema bancario, y cargos por el proceso
pueden resultar. El cheque original es nulo. Por favor destruya si es recibido o recuperado.
6.
Despues de completar, envie todas las páginas originales a:
State Controller's Office
Administration and Disbursements Division - Post Issuance Unit
P.O. Box 942850
Sacramento, CA 94250-5871
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STATE OF CALIFORNIA - CONTROLLER’S OFFICE
REQUEST FOR DUPLICATE CONTROLLER’S WARRANT / STOP PAYMENT
STD 435 (Rev. 10/2019) Page
3
WARRANT NUMBER
(This form is to completed by the Requesting Agency)
DATE ISSUED (MM-DD-YY)
AMOUNT (Net Only)
NAME (Exactly as it appears on warrant)
NAME
ADDRESS
AND ZIP CODE
The State Controller’s Office issued and mailed a duplicate warrant to the payee listed above on
AGENCY ADDRESS (Required):
Page of 3