STAMPED & REDACTED TERESA ANTHONY.PDF

MARICOPA COUNTY
Office of Budget and Finance
301 West Jefferson Street Ste 960
,
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: March 31, 2021 ay
To: Clerk of the Board 4 4
vA @
From: Walter Chang Ey
Office of Budget and Finance Gu
em
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 1 Affidavits for lost warrants to be included on the next available
Board Agenda.
e The attached items have been researched to ensure the warrant in question
have not been cashed or previously re-issued.
e The original warrants have a void/stale date/stop payment done.
Please call me at 506 - 8747 if you have any questions. Please return the approved
Affidavits to my attention in the Office of Budget and Finance , Suite 960.
Thank you.
Re: Fund: 268 /Dept : County Attorney / Company : Teresa Anthony

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form
This application is for: Duplicate or L] 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
paae 2 of this form.
Teresa Anthony (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 26-Jan-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 issued to him/her in the sum of ¢1 234. 15 .(3)
Signed: 7 ee ee (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 5 ii day of MAntr 202/ .
, Se BO Oe
Denyse Good ae , ___sgigriring’a’,
NOTARY PUBLIC SOK
My commission expires: S A%, 6 }
G-5+ COFD> Sal, 4 MOS (seal)
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“1, OF WhSX
Warrant/Check Number MTITITT TS
301 00880293
(if known) (6)
Original Y Date of Issue
26-Jan-2021
(if known) (7)
03/31/2021
Reason for original issue of Warrant/Check (8):
O Payroll
C1 For Services or Goods furnished
() Treasurer's refund/payment
Other: Victim Compensation Check i7T6eAL- |

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010080293
DATE
01-26-2021 91-2/1221
Bank N.A
Phoenix, AZ
One Thousand Two Hundred Thirty Four And 15/100 Dollars
$1,234.15
PAY TO THE ORDER OF AMOUNT
Teresa Anthony
Void After
PHOENIX AZ 85003 365 Days
EF FINANCIAL OFFICER
For Questions - oremail. MARICOPA.GOV NOT NEGOTIABLE
|
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
VICTIM WITNESS 3010080293 01/26/2021 $1,234.15
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
Q0000060088K 1768826-1-rqst7 GAXIF D190 210000010217 675.00 CA
210000010217
oo000060088K 1768826-1-rqst8 GAXIF D190 210000010217 490.00 CA
210000010217
1768826-1-rqst9 GAXIF D190 210000010217 69.15 CA
oo0000060088K
210000010217