ROGER FLORES 100719 SDW FOR 021021 AGENDA.PDF
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U Office of Budget and Finance SER COUNTY ry A. 301 West Jefferson Street Ste 960 202] JAy -5 , AHI: 55 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: January 5, 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 Department of Finance, Suite 960. Thank you. Re: Fund: 100 / Dept :430- Treasurer / Company : Roger Flores 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 COUNTY OF MARICOPA numbers on the Instruction sheet which is paae 2 of this form. Roger nies (1), being first sworn, upon oath deposes and says: —WName/Cramant On or about 07-Oct-2019 (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 probebility of its being found or presented for payment, ar 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) ve. Pleas6 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 day of 20 NOTARY PUBLIC SS =< , My commission expires: SLKG Warrant/Check Number 239 Original Date of Issue 07-Oct-2019 ~ (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll 0 For Services or Goods furnished Treasurer's refund/payment Original check presumed lost in the mail @ Other: JURAT WITH AFFIANT STATEMENT 8202 CAMPORNEA ns CODE bs [See Attached Document (Notary to cross out lines 1-6 below) 1 See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of Subscribed and sworn to (or affirmed) before me Cortes ‘a County of . ere HOW RY . on this 2© day ot Decenbor_, — 2020, 5 1 13 3 1 2 1452 1717 84 30 96.492905 Date 5 1 13 3 1 3 1832 1712 118 47 96.594635 Month 5 1 13 3 1 4 2149 1715 83 31 96.312599 Year 2 1 14 0 0 0 1281 1758 670 110 -1 3 1 14 1 0 0 1281 1758 670 110 -1 4 1 14 1 1 0 1281 1758 670 110 -1 5 1 14 1 1 1 1281 1758 79 110 34.968266 )_ 5 1 14 1 1 2 1396 1758 138 110 57.391518 Ros 5 1 14 1 1 3 1547 1805 101 37 8.204784 Er 5 1 14 1 1 4 1697 1766 254 79 52.096100 Flores 2 1 15 0 0 0 1268 1866 972 90 -1 3 1 15 1 0 0 1268 1866 972 90 -1 4 1 15 1 1 0 1268 1866 972 90 -1 5 1 15 1 1 1 1268 1912 77 39 96.314636 (and 5 1 15 1 1 2 1372 1911 40 40 96.775940 (2) 5 1 15 1 1 3 1621 1879 59 76 53.064671 AN 5 1 15 1 1 4 1684 1866 48 90 0.000000 Fi; 5 1 15 1 1 5 1720 1881 58 62 17.804203 V2 5 1 15 1 1 6 2222 1910 18 39 50.357353 ), 2 1 16 0 0 0 1634 1947 403 62 -1 3 1 16 1 0 0 1634 1947 403 62 -1 4 1 16 1 1 0 1634 1947 403 62 -1 5 1 16 1 1 1 1634 1947 203 56 22.448244 Name(s)_of 5 1 16 1 1 2 1846 1964 191 45 85.505287 Signer(s)_ 2 1 17 0 0 0 1312 1843 933 5 -1 3 1 17 1 0 0 1312 1843 933 5 -1 4 1 17 1 1 0 1312 1843 933 5 -1 5 1 17 1 1 1 1312 1843 933 5 95.000000 2 1 18 0 0 0 298 1939 694 240 -1 3 1 18 1 0 0 298 1939 694 240 -1 4 1 18 1 1 0 301 1939 211 147 -1 5 1 18 1 1 1 301 1939 211 147 95.000000 4 1 18 1 2 0 298 2086 694 93 -1 5 1 18 1 2 1 298 2086 694 93 95.000000 2 1 19 0 0 0 1414 1943 789 4 -1 3 1 19 1 0 0 1414 1943 789 4 -1 4 1 19 1 1 0 1414 1943 789 4 -1 5 1 19 1 1 1 1414 1943 789 4 95.000000 2 1 20 0 0 0 514 1949 471 206 -1 3 1 20 1 0 0 514 1949 443 206 -1 4 1 20 1 1 0 555 1949 365 33 -1 5 1 20 1 1 1 555 1954 126 27 93.278755 CHRISTY 5 1 20 1 1 2 693 1949 227 33 89.339310 ANDREI-MOORE 4 1 20 1 2 0 560 1995 357 36 -1 5 1 20 1 2 1 560 1997 90 31 96.834183 Notary 5 1 20 1 2 2 664 1996 84 26 93.215012 Public 5 1 20 1 2 3 763 2010 8 4 92.950256 - 5 1 20 1 2 4 784 1995 133 36 96.849983 California 4 1 20 1 3 0 600 2037 275 33 -1 5 1 20 1 3 1 600 2038 167 27 96.679924 Sacramento 5 1 20 1 3 2 780 2037 95 33 96.534210 County 4 1 20 1 4 0 564 2078 348 29 -1 5 1 20 1 4 1 564 2079 173 28 93.267822 Commission 5 1 20 1 4 2 752 2081 22 25 93.267822 # 5 1 20 1 4 3 787 2078 125 28 96.499702 2186198 4 1 20 1 5 0 514 2120 471 35 -1 5 1 20 1 5 1 514 2122 38 33 96.396469 My 5 1 20 1 5 2 564 2121 94 27 96.396469 Comm. 5 1 20 1 5 3 671 2121 97 33 96.763031 Expires 5 1 20 1 5 4 785 2120 44 27 94.139908 Mar 5 1 20 1 5 5 843 2120 37 30 94.139908 11, 5 1 20 1 5 6 894 2120 91 33 92.708885 2021 5 1 20 1 5 7 968 2116 19 43 60.753429 ff 2 1 21 0 0 0 1269 2060 974 41 -1 3 1 21 1 0 0 1269 2060 974 41 -1 4 1 21 1 1 0 1269 2060 974 41 -1 5 1 21 1 1 1 1269 2062 122 39 96.368767 proved 5 1 21 1 1 2 1412 2063 35 29 96.910545 to 5 1 21 1 1 3 1469 2070 55 22 96.562675 me 5 1 21 1 1 4 1544 2069 43 23 94.562271 on 5 1 21 1 1 5 1608 2061 57 31 96.604553 the 5 1 21 1 1 6 1686 2061 92 31 96.056160 basis 5 1 21 1 1 7 1799 2061 35 30 96.836548 of 5 1 21 1 1 8 1853 2060 208 39 96.342934 satisfactory 5 1 21 1 1 9 2081 2060 162 31 96.203262 evidence 2 1 22 0 0 0 1267 2110 973 122 -1 3 1 22 1 0 0 1267 2110 973 122 -1 4 1 22 1 1 0 1267 2110 973 122 -1 5 1 22 1 1 1 1267 2114 36 28 96.088058 to 5 1 22 1 1 2 1334 2112 45 30 96.088058 be 5 1 22 1 1 3 1407 2111 59 31 96.222275 the 5 1 22 1 1 4 1497 2110 193 40 85.886169 person(s). 5 1 22 1 1 5 1702 2110 288 122 29.388145 in 5 1 22 1 1 6 2023 2110 120 31 96.440224 before 5 1 22 1 1 7 2174 2118 66 22 96.843964 me. 2 1 23 0 0 0 1267 2198 593 105 -1 3 1 23 1 0 0 1267 2198 594 105 -1 4 1 23 1 1 0 1267 2198 593 105 -1 5 1 23 1 1 1 1267 2260 176 39 96.313164 Signature 5 1 23 1 1 2 1545 2198 114 105 0.000000 __ 5 1 23 1 1 3 1702 2198 158 105 0.000000 #-— 2 1 24 0 0 0 1602 2317 491 39 -1 3 1 24 1 0 0 1602 2317 491 39 -1 4 1 24 1 1 0 1602 2317 491 39 -1 5 1 24 1 1 1 1602 2317 176 39 96.040016 Signature 5 1 24 1 1 2 1793 2317 39 31 96.040016 of 5 1 24 1 1 3 1841 2317 125 39 96.536171 Notary 5 1 24 1 1 4 1978 2317 115 31 96.336967 Public 2 1 25 0 0 0 971 1959 21 202 -1 3 1 25 1 0 0 958 1929 34 232 -1 4 1 25 1 1 0 971 1959 21 202 -1 5 1 25 1 1 1 954 2107 46 54 0.000000 IB 5 1 25 1 1 2 971 2027 20 69 0.000000 LYNN 5 1 25 1 1 3 958 1929 12 87 0.000000 EE 2 1 26 0 0 0 1452 2291 792 4 -1 3 1 26 1 0 0 1452 2291 792 4 -1 4 1 26 1 1 0 1452 2291 792 4 -1 5 1 26 1 1 1 1452 2291 792 4 95.000000 2 1 27 0 0 0 546 2451 462 92 -1 3 1 27 1 0 0 546 2451 462 92 -1 4 1 27 1 1 0 737 2451 81 32 -1 5 1 27 1 1 1 737 2451 81 32 96.550186 Seal 4 1 27 1 2 0 546 2497 462 46 -1 5 1 27 1 2 1 546 2498 101 30 96.245819 Place 5 1 27 1 2 2 661 2498 124 38 96.166679 Notary 5 1 27 1 2 3 797 2497 80 31 96.766426 Seal 5 1 27 1 2 4 886 2497 122 46 96.349632 Above 2 1 28 0 0 0 1382 2550 861 8 -1 3 1 28 1 0 0 1382 2550 861 8 -1 4 1 28 1 1 0 1382 2550 861 8 -1 5 1 28 1 1 1 1382 2550 861 8 95.000000 2 1 29 0 0 0 288 2553 855 7 -1 3 1 29 1 0 0 288 2553 855 7 -1 4 1 29 1 1 0 288 2553 855 7 -1 5 1 29 1 1 1 288 2553 855 7 95.000000 2 1 30 0 0 0 1157 2551 210 31 -1 3 1 30 1 0 0 1157 2551 210 31 -1 4 1 30 1 1 0 1157 2551 210 31 -1 5 1 30 1 1 1 1157 2551 210 31 96.150520 OPTIONAL 2 1 31 0 0 0 343 2606 1850 79 -1 3 1 31 1 0 0 343 2606 1850 79 -1 4 1 31 1 1 0 343 2606 1850 42 -1 5 1 31 1 1 1 343 2609 136 39 96.700439 Though 5 1 31 1 1 2 496 2609 64 31 96.724937 this 5 1 31 1 1 3 573 2608 132 31 96.419968 section 5 1 31 1 1 4 720 2608 28 31 96.419968 is 5 1 31 1 1 5 763 2608 154 39 96.529739 optional, 5 1 31 1 1 6 936 2608 207 39 96.747566 completing 5 1 31 1 1 7 1159 2608 62 30 96.989067 this 5 1 31 1 1 8 1235 2607 207 31 96.717033 information 5 1 31 1 1 9 1458 2615 64 23 95.522629 can 5 1 31 1 1 10 1537 2607 98 31 95.522629 deter 5 1 31 1 1 11 1646 2606 169 31 96.508430 alteration 5 1 31 1 1 12 1831 2606 40 31 96.630112 of 5 1 31 1 1 13 1881 2606 56 31 96.763153 the 5 1 31 1 1 14 1952 2606 189 31 96.438393 document 5 1 31 1 1 15 2154 2613 39 23 96.999069 or 4 1 31 1 2 0 659 2652 1208 33 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