STAMPED & REDACTED FOR AGENDA ATTACHMENT - BRADLEY YOUNG.PDF

MARICOPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9" Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

Maricopa.gov

To: Clerk of the Board
From: Office of Budget & Finance, Accounts Payable
Date: 6.9.23

Subject: Affidavit — Bradley Young

Please find attached one Affidavit for a stale dated to be included on the next
available Board Agenda.

e Theattached item has been researched to ensure the warrant in question has not
been cashed or previously re-issued.

e The original warrant is presumed lost.

Please call Marcia Bulanda at 506-7291 if you have any questions. Please return the
approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor.

Thank you.

Re: FUND 675 ~ D750 RISK MANAGEMENT — GAX1D 23*2886 ~ WC5005042139438
YOUNG LEC SEPT22

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/ Claim Forrr

This application is for: kal Duplicate or Cl State-Dated {definitions are on page 2}

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA nurnbers on the Instruction sheet which is
pade 2 of this form.
BRADLEY YOUNG (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 11-Aug-2022 (date)(2) a warrant/check was issued to the

above named person/entity in the amount as stated below. Such warrant/check was
either never received or was subsequently inadvertently lost or destroyed ancl there is
no reasonable probability of its being found or presented for payment, ar it was not
presented for payment within one year after the date of issuance.

Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $ 1,017.24 (3)
Signed: Bot (4)

Note, Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

SS Subscribed a and sworn to before me this _| 3th day of Ane: l 2023.

NOTARY PUBLIC Fema Zo

gilli, _ JENNICA LOYD
My commission expires: cee bee rat Soluce
22L291 28 EL a Samson sa (seal
les aT oc aoa ae at
Warrant/Check Number |
{if known) (6) 30101 24327
Original Date of Issue
(if known) (7) 11-Aug-2022
. 6/12/2023
Reason for original issue of Warrant/Check (8): =

O Payroll
(1 For Services or Goods furnished

CI Treasurer's refund/payment
Other. / original check presumed lost in the mail

D750 RISK MANAGEMENT - GAX1D 23*2886 - WC5005042139438 YOUNG LEC SEPT’22

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER

PHOENIX, ARIZONA 3010124327
DATE

One Thousand Seventeen And 24/100 Dollars

$1,017.24
PAY TO THE ORDER OF
BRADLEY YOUNG AMOUNT

Void After
365 Days

For Questions - 602-506-1379 or email AP@MAIL MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE oo

RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS

SETTLE 3010124327 08/11/2022 $1,017.24
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
922YOUN WC5005042139438 YOUNG LEC SEPT'22 GAX1D D750 230000002886 1,017.24]PU
230000002886