STAMPED & REDACTED HLP INC.PDF

MARICOPA COUNTY nM ARICORS Cr uSoR
Oo
Office of Budget and Finance
son
301 West Jefferson Street , Ste 960 eUeiMAR 1S PH 4:33
Phoenix, Arizona 85003
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INTEROFFICE MEMORANDUM
Date: March 15, 2021
To: Clerk of the Board
From: Walter Chang
Office of Budget and Finance
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: 572 / Dept: Animal Control / Company: HLP INC

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form
This application is for: Duplicate or C] 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.
HLP INC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 31-Dec-2020 (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 isStied to him/her in the sum of $ 18,902.01 (3)
signed Lach ecb
( (4)
Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
US }
(5) Subscrib¢d and sworn to before me thi day of (Warch 207 | .
6 —
NOTARY PUBLIC _ ~ KRISTOPHER PAEK
NOTARY PUBLIC
STATE OF COLORADO
My eV psa PA als) NOTARY ID 20064032549
ae MY COMMISSION EXPIRES 08/27/2022 (s@al)
| LE
Warrant/Check Number
3010078356
> Pk
werenfan
rigina jorsene! o__ {31-Dec-2020 03/16/2021
_—
Reason for original issue of Warrant/Check (8):
1 Payroll
/ Database Software
For Services or Goods furnished
| Treasurer’s refund/payment
/ presumed lost in the mail
Other:

HLP, INC.
phone:
fare
3/8/2021
|, Keith Brakey, authorize Kristin Schiechl, Director of Operations, to execute an
affidavit on behalf of HLP, Inc.
Yours truly,
Keith Brakey
Chief Operating Officer
HLP, Inc.