STAMPED & REDCATED - FOR AGENDA ATTACHMENT - DAILY JOURNAL CORPORATION.PDF

MARICOPA
COUNTY

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

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

Maricepa.gov

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

Subject: Affidavit — Replacement of Lost Warrant

Please find attached one Affidavit for a lost warrant 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 Jost.

Please call Walter Chang at 506-8747 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 504 — D850 / DAILY JOURNAL CORPORATION

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or (Cl stale-Dated (definitions are on page 2)

i

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.

DAILY JOURNAL CORPORATION (1), being first sworn, upon oath deposes and says:

NamerCrainant

On or about 05-Jan-2023 (date)(2) a watrant/check was issued to the
above named persan/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 him/her in the sum of $ 12.86 3)
Signed: _C* Dern Bad ch : (4)

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

(5) Wet pe before me this ii Y day of ApUL 2028.

NOTARY PUBLIC [a mre
: DEBBIE YERKES
S Reel - Notary Publlc- California = &

RNAS

Los Angeles County =
Commission #2439799 gf
My Comm, Expires Mar 9, 2027

TANS eae

(seal)

| Warrant/Check Number 1.34494 39503

(if known) (6)

Original Date of Issue
(if known) (7) 05-Jan-2023

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

1 Payroll ;
For Services or Goods furnished / Newspaper and Publication Advertising

0 Treasurer's refund/payment
Other: / check presumed lost / fund : 504

4/24/2023

Daily Journal

Los Angeles Daily Journal
Sau Francisco Daily Journal
www.dailyjournal.com

£. First Street

Daily Commerce
www.dailycommerce,news
SISE First Street

Los Angeles, CA 90012
(213) 239-5300

Business Journal
www.riversidcjournabnews
4152 10" Street

Riverside, CA 92501

(953) 784-0111

Orange County Reporter
SHIYW.OCYC Par ler ews.

600 W, Santa Ana Bivd., Ste, 205
Santa Ana, CA 92701

G4) 543-2027

The Daily Transcript
wovw.sdttanscriptcom
2652 Fourth Avenue, 2nd FI.
San Diego, CA 92103

(619) 232-3486

The Daily Recorder
www.dailyrecorder.news
OU “H" Street, Ste, 312
Sacramento, CA 95814
16) 444-2355

The tuter-City Express
wiww.intercityexpress.news
1109 Oak Street, Ste. 103
Oakland. CA 94607

(810) 272-4747

San Jose Post-Record
wiv. postrecord.news
94S, Markel Street, Ste, 535
San Jose, CA 95113

(408) 287-4866

The Record Reparter

www. recordreporier.com
2025 N, Third Street, Ste, 200
Phoenix, AZ 83004

(602) 417-9900

wwaww.LegalAdstore.com
wwww.DBAstore.com

CORPORATION

April 21, 2023

execute an affidavit on behalf of Daily Journal Corporation.

Yours truly,

fhitlt-

Michelle Stephens
Legal Advertising Manager

I, Michelle Stephens, authorize Claudia Hernandez, Accounts Receivables, to