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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM REc Date: July 2, 2021 TECEIVED Thong Q3,"° To: Clerk of the Board 97 any, ChE p MARCO R, -- RK From: Beth Brown BOARD Of SULNTY Department of Finance ERVISORS Subject: Affidavit — Replacement of Lost Warrant Please find attached affidavit for 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. e The original warrant has a void/stale date/stop payment done. Please call me at 506-1329 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: JEROD POSTHUMAS DEPT 220 FUND 222 Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/ Claim Form This application is for: Duplicate or I 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 pade 2 of this form. JEROD POSTHUMUS (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 14-May-2021 (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 her in the sum of $ 0,300.00 (3) erie wu Signed: (4) Of Note, Please attach a copy 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_2-*'" __ day of Dane 202/ on ROBA, JOSH ROBERTS NOTARY PUBLIC Ra Notary Public 3 “yoTARia’. = for the State of Montana My commission expires: sh. SEAL 2 Bozeman, Meniana B/2S/ 20H RG VOOS My Commission Expires: (seal) Mtr) September 25, 2024 Warrant/Check Number 3010088695 check NU Original Date of Issue 14-May-2021 (iF known) (7) Reason for original issue of Warrant/Check (8): C1 Payroll 07/07/2021 © For Services or Goods furnished 1 Treasurer's refund/payment Rental assistance payment Other: