STAMPED & REDACTED DEBRA YOCUM.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: June 24, 2021
To: Clerk of the Board
From: Beth Brown
Department of Finance
Subject: Affidavit — Notice of Claim
Please find attached Affidavit for stale dated warrant to be included on the next
available Board Agenda.
e The attached item has been researched to ensure that 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: DEBRA YOCUM
Dept 220
Fund 222

Application for 4 Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: [1 Duplicate _or [J Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note; Nurnbers on this form coiresporid to
GOUNTY OF MARIGOPA hurmbers on the listruction sheet whieh is
| bade 2 of this form
DEBRA YOCUM
_.. (1) -belng-firsbeworr-upen
“~“Name/Glaimant
On or about 29-May-2021 (data)(2) a watrant/check was issued to the
above named persori/entity in the amourit as stated below. Such warrant/check was
either never réceived or was subséquently inadvertently lost or destroyed and there is
fo reasonable probability of Its béing found of 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
war be issued to him/her in the sum of $ 7,800.00 (3)
rant/check
Dolora 2
Signed: fOCL LIV) 4
‘of
Note; Please attach a copy the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
) Subscribed arid swore befaré/riye his 2h day of: June, 202/,
OREMA GROLLO
Notary Public - Arizona
My corrmission expires: Maricopa County
GAT 9? Cammission # 555461
Ja Hy Comm. Expires Dec 7, 2022
¢
Warrant/Check arran Nun Number. er 3010080463 _
ih inca)
~ : —_
Original Date of Issue
__ GF known) (7). _
Reason for original issue of Warrant/Check (8):
OC Payroll
[ For Services or Goods furnished...
LC} Treasurer's refurid/payment 06/25/2021
J Other: Rental assistance payment ~
2

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