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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 2111S NOV 13 PM 2: 37 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: November 13, 2019 To: Clerk of the Board From: Walter Chang Department of Finance Subject: Affidavits — Replacement of Lost Warrants Please find attached 1 Affidavits for lost warrants to be included on the next available Board Agenda. • The attached items have been researched to ensure the warrant in question have not been cashed or previously re-issued. • 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 : 219 / Dept :190 / County Attorney / Company : April Martinez Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or 0 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 Dace 2 of this form. April Martinez (1), being first sworn, upon oath deposes and says: Name/claimant On or about 13-Sep-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 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 bimTher in the sum of $ 338 . 29 .(3) Signed: (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 a day of t'-' r 20 19. Agee", re. ez NOTARY PUBLIC VERONICA RAZO Moiety Public - State of Arizen• MARICOPA COUNTY My commission expires: Commission #553630 Expires November 6,2022 - (seal) Warrant/Check Number 3010049t2 429 co (if known) (6) Original Date of Issue 13-Sep-2019 (if known) (7) APPROVED Reason for original issue of Warrant/Check (8): DATE „NOV 11 2019 Li Payroll 0 For Services or Goods furnished El Treasurer's refund/payment Other: Victim Compensation Check: VC2016000744-1 Req 4