STAMPED AND REDACTED - 3010248731 - TAVIN JONES.PDF

Office of Budget & Finance To: Clerk of the Board
301 W. Jefferson St., 9th Floor From: Office of Budget & Finance, Accounts Payable
Phoenix, Arizona 85003
Date: 8-26-2026
Subject: Affidavit ― Replacement of Lost Warrant
P: 602-506-3561
F: 602-506-4451
Please find attached one Affidavit for a lost warrant to be included on the next
Maricopa.gov available Board Agenda.
• 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 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, 9th Floor.
Thank you.
Re: Fund : 675 / Dept : Risk Mgmt / vendor name : TAVIN JONES

Application for a Duplicate or stale Dated
Warrant/Check Affidavit/Claim Form
. This appllcatlon Is for Н Duplicate or D Stale-Dated (deflnltlona are on page 2)
STATE OF ARIZONA • Note: Numbers on ihts torm Оorrespond io ihe number!!
COUNTY OF MARICOPA on the Instruction sh11et which 111 page 2 of this form
_T_av_ln_J_o_n_es..,.,....___,,,,.,...,..-,-------(1), being first sworn, upon oath deposes and says:
Name/Clnlmant
On or about 08/14/2026 (date) (2) a warrant/check was Issued to the above named
person/entity In the amount stated below. Such warrant/check was either never received or
was subsequently Inadvertently lost or destroyed and there Is no reasonable probablllty of Its
being found or presented for payment. ru: 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 spawn Is due and owing, and the applicant requests ·, that a replacement warrant/check
be Issue o her In the sum of $2,844,JП.- . ., (3)
• .. • •• .. ,
Slg ed: (4)
Prln N, e: (required)- • • J c.-,.,,·0, . .S . ., . ·.·. ,, . ...... .
Note: Please attach a copy of tile warrant/check If available and/or any other evidence that a
warrant/check was orlg/nal/y Issued.
(5) SubscrrР,ed and sworn to before me this .. fdS-,._day of .... AU§ us+ 20.ak...
•,.,,,I,. (7m . • • •
, NOTARY PUBLioJ 1
' CINDY JONES
i) Nolliy —l˜™COUNi Pub m Ila •Slate 110081 of AlfZOIIII
My commission expires:
A-Dril. !)], @'2J.£'. . Elcplres Ap,ff 27, 202 (seal),
... . f':':' .. .... . .. -.'-... ,-
, Warrant/Check Number
(If known) (6) :3010248731
' Ol'lglnal Date of Issue 8/14/2026
Qf known) (7) ... '-
Reason for orlglnal Issue of Warrant/Check (8):
□Payroll _______________________ _
□For Services or Goods furnished _______________ _
□Treasurer's refund/payment _________________ _
ta Other: Check was mailed to an incorrect address
S:\PROCESSES\Wammts • Duplloate or stale\02 Forma\Current Claim Form\ 100618 Warrants Cheoko notice of G!alm,doo Rovlsed
100518
r·
A,R,S, 1 H32 & 1 H44