SIGNED & REDACTED ENCOURAGE EMPOWERMENT LLC.PDF

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Office of Budget and Finance ond
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301 West Jefferson Street , Ste 960 2021 ch PM 3:31 pare
Phoenix, Arizona 85003 Oelin
INTEROFFICE MEMORANDUM
Date: February 24, 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: 268 / Dept: County Attorney / Company: ENCOURAGE EMPOWERMENT LLC

“
Walter Chang (FIN)
From: Joyce Maurmann (FIN)
Sent: Wednesday, February 24, 2021 1:07 PM
To: Walter Chang (FIN)
Ce: Teresa Finley (FIN); Beth Brown (FIN); FIN AccountsPayable
Subject: RE: affidavit / D190
Hi Walter,
| reviewed the documents, please submit to BOS.
Thanks,
Joyce Maurmann
Accounts Payable Supervisor
Maricopa County Department of Finance
Phone: | Fax: A/P Phone:
Website: http://
From: Walter Chang (FIN)
Sent: Wednesday, February 24, 2021 10:40 AM
To: Joyce Maurmann (Flix)
Cc: Teresa Finley (FIN) < >; Walter Chang (FIN) >; Beth Brown
;
(FIN)<) ~ f°, >; FIN AccountsPayable <
Subject: affidavit / D190
Hello. Please review the docs before | bring it up to the BOS.
Thank you.
Walter Chang
Maricopa County
Office of Budget and Finance
AP Phone:

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form
This application is for: Duplicate or LJ State-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.
Le
(
Foc marage Emppwermel fy, being first sworn, upon oath deposes and says:
On or about 01-Jun-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
to him/her in the sum of $41 2.5 .(3)
mee
Signed: VW AZA_Z Ol ne (4)
> TOnnrp
Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
scribed and Son day of Ochiner 2020)..
rem eee
OTARY PJBLIC » LAUREN
aN Notary Pablo aeORET
(IARICOPA COUNTY
“oci ;
hel 2 expires: Expires May 4 504366
My 3)
Warrant/Check Number
Original Date of Issue
01-Jun-2020
(if known) (7) 02/25/2021
Reason for original issue of Warrant/Check (8):
C1 Payroll
(1 For Services or Goods furnished
C1 Treasurer's refund/payment
other: Victim Compensation Check fC 2.01G N000U 7-1 Rey 48

canine
potvernten|,
Mesa, AZ 85202
Phone: / Fax:
February 15, 2021
Kristen. Trohkimoinen
Phoenix, AZ 85003
Re: Victims Compensation Check
Dear Kristen,
On June 1, 2020, a check was issued to Encourage Empowerment LLC for $412.50 with the
warrant number 3010059610. We have not received this check, and it has not been cashed.
Please see the included affidavit regarding duplicate check, signed by Tammy Ohm, Clinical
Director.
Thank you, and please let us know if there is anything else you need for this request.
Tammy Ohm
Clinical Director

y *
CQUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
__
PHOENIX, ARIZONA 3010059610
DATE
06-01-2020 91-2/1221
0 Bank NA
Phoenix, AZ
Four Hundred Twelve And 50/160 Dollars
$412.50
PAY TO THE ORDER OF AMOUNT
ENCOURAGE EMPOWERMENT LLC
Void After
365 Days
Lor Questions - or email - MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE.
RETAIN THIS POR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
ENCOURAGE EMPOWERMENT LLC 3010059610 66/01/2020 $412.50
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
00000057676K VC2018000047-1-rqst48 GAX1D D190 200000038028 412.501CA
200000038028