STAMPED & REDACTED - FOR AGENDA ATTACHMENT - JAMES M DEDDO JR .PDF

a

~

ee

L

v
MARICOPA
COUNTY

oe

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: §.23.23

Subject: Affidavit — James M. Deddo Jr.

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

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

® The original warrant is presumed lost.

Please call Marcia Bulanda at 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 766 — D180 — GAX 23*00330 — PSPRS TIERS 1 & 2 EXCESS CONTRIBUTION
REFUND — INTEREST PORTION SEPT 2022

Application for a Duplicate or Stale-Dated Warrant /Check

Affidavit/Claim Form

This application is for: Duplicate or (3 state-pated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on-this form correspond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is
paae. 2 of this form,
JAMES M. DEDDO JR. (1), being first sworn, Upon cath deposes arid says:
Name/Claimant
On or about 23-Sep-2022 (date)(2) a warrant/check was issued fo 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 and there is
no reasonable probability of its being found or presented for payment, or 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 (SOx. in the sum bccn 37.60 . + (3)

Signed: a OSa,

Note: Pleads attach @ copy of nL warrant/check if available onan any other
evidence that a warrant/check was originally issued.

aeace |

(5) Subscribed and sworn to before me this . _/ Gb day of ie Deif 20.23.
By. Sanes Mh. Deddo Se. ASA

NOTARY PUBLIC Jo eo

B SKINNER
Notary Public - Arizona
Pinal County

Commission #5662
M Som Expires 06/26

My commission expires:

esl

Warrant/Check Number 3010128168

{if known) (6)

Original Date of Issue
9 (if known) (7) 23-Sep-2022

5/23/2023

Reason for original issue of Warrant/Check (8):

QO Payroll
( For Services or Goods furnished

1 Treasurer's refund/payment
Other: / original check presumed lost in the mail

FUND 766.- D180-FINANCE = - GAX 23°00330
PSPRS Tiers 1 & 2 Excess: Contribution Refund - Interest Portion Sept 2022