STAMPED & REDACTED ERIC LAVINE.PDF

MARICOPA COUNTY
Office of Budget and Finance
301 West Jefferson Street Ste 960
,
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM Poe
a
Date: March 16, 2021 25
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To: Clerk of the Board Ag
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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: 675 / Dept: Risk Mgmt / Company : ERIC LAVINE

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or _] stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
numbers on the Instruction sheet which is
COUNTY OF MARICOPA
paae 2 of this form.
ERIC LAVINE (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 19-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 ¢ 365.62 (3)
Zan. ~ (4)
Signed:
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) orn to before me this __ /Z.__day of Fepenoen _ 202 .
Subscriber
2
AMBER FLORES
KSA Notary 1D #132376310
mmission expires: YS ie) My Commission Expires
PSY February 26, 2024 (seal)
ferevety DW, LZ
Warrant/Check Number 3010079515
(if known) (6)
Original g Date of Issue 49-Jan-2021 03/16/2021
cenewmn |
Reason for original issue of Warrant/Check (8):
O Payroll
furnished_/ MSETTLE check
For Services or Goods
C Treasurer’s refund/payment
/ Original check presumed lost in the mail
Other:

Walter Chang (FIN)
From: FIN AccountsPayable
Sent: Friday, February 12, 2021 3:16 PM
To: Walter Chang (FIN)
Ce: Beth Brown (FIN); Teresa Finley (FIN); FIN AccountsPayable
Subject: RE: Check / ERIC LAVINE 3010079515 Feb 12-2021.pdf
Hi Walter,
| reviewed the document, please have payee mail the documents.
Thanks,
Joyce Maurmann
Accounts Payable Supervisor
Maricopa County Department of Finance
Phone:
A/P Phone:
Website: http://www.maricopa.gov/finance/
MARICOPA COUNTY
OpenBooks
best flust through transp ney
From: Walter Chang (FIN) <
Sent: Friday, February 12, 2021 2:34 PM
To: Joyce Maurmann (FIN) <.
Cc: Beth Brown (FIN) Teresa Finley (FIN) <
AccountsPayable <FINAccountsPayable@maricopa.gov>; Walter Chang (FIN)
Subject: RE: Check / ERIC LAVINE 3010079515 Feb 12-2021.pdf
Travis emailed me right now this pdf.
From: Walter Chang (FIN) <
;
Sent: Friday, February 12, 2021 2:23 PM
To: Joyce Maurmann (FIN) < :
Cc: Beth Brown (FIN) <° as >; Walter Chang (FIN) < Teresa Finley
(FIN) <. - > >; FIN AccountsPayable < .
Subject: FW: Check i ERIC LAVINE 3010079515 Feb 12-2021. pdf
Hello. Please review this before | email Travis McCullough to have Eric
mail the docs in.

Thank
you.
Walter Chang
Maricopa County
Office of Budget and Finance
AP Phone: ~
From: Travis McCullough (RMD) <’
Sent: Friday, February 12, 2021 1:10 Pw
To: Walter Chang (FIN) <
Subject: FW: Check
| received this from Mr. Lavine today.
Thank you
Travis McCullough
Workers’ Compensation Claims Adjuster
Maricopa County Risk Management
Phone: aan | Fax: .
General Questions Email:
Claim Form Link: http://
Comments? Complaints? Take our claims survey!
From: eric lavine <
Sent: Friday, February 12, 2021 1:06 PM
To: eric lavine < ; >; Travis McCullough (RMD)
Subject: RE: Check

Sent from Yahoo Mail on Android
On Fri, Feb 5. 2021 at 8:30 AM, eric lavine
< wrote:
_
Good morning,
Am checking in to see the status regarding January check? Have you all change the dates in mailing check? When
retrieving check it's use to be mail out on 23rd of each month and retrieve on 26th of each month. What happen with
the schedule of mailing it out on 23rd of each month? Are you able to inform me of when check will be mail out each
month? You have the correct update home address?
Thank you,
Eric Lavine
Sent from Yahoo Mail on Android
On Thu, Jan 14, 2021 at 11:56 AM, eric lavine
< : _ > wrote:
Yes.
Sent from Yahoo Mail on Android
On Thu, Jan 14, 2021 at 9:05 AM, Travis McCullough (RMD)
< : v> wrote:
Would you like me too update this as your new mailing address?
Travis McCullough
Workers’ Compensation Claims Adjuster
Maricopa County Risk Management
| Phoenix, AZ”
Phone: | Fax:
General Questions Email: :
Claim Form Link: http://.

Comments? Complaints? Take our claims survey!
From: eric lavine < >
;
Sent: Wednesday, January 13, 2021 5:38 PM
To: Travis McCullough (RMD) <
Cc: eric lavine <-
Subject: RE: Check
Disregard email retrieve it on last Saturday. Thank you for responding back to me. FYI, the PO Box will be forwarding all
mail to my home address which is:
Thank you,
Eric Lavine
Sent from Yahoo Mail on Android
On Wed, Jan 13, 2021 at 4:37 PM, Travis McCullough (RMD)
<
We have not received a returned check and are mailing to PO BOX i Know there
may be delays with the postal service. If the mailing address has changed please let me know.
Thank you
Travis McCullough
Workers’ Compensation Claims Adjuster
Maricopa County Risk Management
Phone: | | Fax:
General Questions Email:
Claim Form Link:
Comments? Complaints? Take our claims survey!

From: eric lavine < >
Sent: Friday, January 8, 2021 11:22 AM
To: Travis McCullough (RMD) <
Cc: eric lavine < >
Subject: Re: Check
Good afternoon,
Am checking to see if December check has been return back to you? Have not received my December check.
What do | need to do in order to retrieve it?
Thank you
Eric Lavine
Sent from Yahoo Mail on Android