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MARICOPA COUNTY Office of Budget and Finance 301 West Jefferson Street Ste 960 e02iMAR-|] AMI: 5) , Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: March 1, 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: 219 / Dept: County Attorney /Company: Alma Hurtado-Ramirez Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/Claim Form This application is for: C] Duplicate or 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. Alma Hurtado-Ramirez (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 02-Jul-2017 (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 (3) (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 a4 day of Fe e bevac, JY 2a. ” NOTARY PUBLIC VERONICA RAZO Notary Public - State of Arizona My commissjon expires: MARICOPA COUNTY l [ G, . 3 a Expires Commission November 6, 2022 (seal) y Werentfgemer 00000055325K / = 0) 00 V¥s 44 Original Date of Issue 25-N ov-20 1 9 (if known) (7) Reason for original issue of Warrant/Check (8): [1 Payroll O For Services or Goods furnished L) Treasurer’s refund/payment Check was never cashed Other: