This form is part of the Stop Payment letter. However, OCC states this form should be an OBM form.
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REQUEST TO STOP PAYMENT AND REISSUE DISASTER ASSISTANCE CHECK
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Schedule Number: {MCHK_SCHED_NR} Amount: ${MCHK_AMOUNT}
Due to circumstances beyond my control, I am not able to locate and/or cash the U.S. Department of the Treasury check issued to me for disaster assistance from the Federal Emergency Management Agency (FEMA).
Therefore, I, ________________________________, would like to request that FEMA stop payment on the check previously issued to me and reissue a check to me in the same amount.
I hereby declare under penalty of perjury that the foregoing is true and correct.
____________________________________ ____________________
Signature Date
My current mailing address is: __________________________________________________________________
__________________________________________________________________
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Aponte Olmo, Rafael |
File Modified | 0000-00-00 |
File Created | 2021-01-14 |