REDACTED-FOR AGENDA ATTACHMENT - 3010191513 - LOWES.PDF

v
MAR)COPA
COUNTY

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

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

Marlcopa.gov

To: Clerk of the Board

From: Office of Budget & Finance, Accounts Payable
Date: 06/17/26

Subject: Affidavit - LOWE'S

Please find attached one Affidavit for a STALE DATED warrant to be included on the
next available Board Agenda.

¢ The attached iter 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 Anderson 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: D190 COUNTY ATTORNEY ~ FUND 716 - GAX1D 25*3409 - FDP-DANIELLE VOLP
CR2024-100716-005-1-1

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Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form

This application is for: Duplicate or x Stale-Dated (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

L F paae 2 of this form.
owes >
NaNiSTCSWAI (1), being first sworn, upon oath deposes and says:

On or about 29-Aug-2024 (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 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 $. 1,975.75 (3)

Signed: »: h q NG (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) Subscribed and sworn to before me this BS* day of Prori } 202% .

Mita,
Dew, BIO oSQWATE sy,

NOTARY PUBLIG> SHOES
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My commission expires: = oy o fo=
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Warrant/Check Number ELL COM WS
(If known) (6) 3010191513 “ani
Original Date of Issue
(if. known) (7) 29-Aug-2024

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

OD Payroll
O For Services or Goods furnished

C1 Treasurer's refund/payment
Other: MVICTIM / GAX1D 25*3409/ FUND 716 - VY) 14 b- Cova Sxorney

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