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RECEIVED ' 82DN'tti MARICOPA COUNTY NOV 2 6 2019 Department of Finance MARICOPA COUNTY 301 West Jefferson, Ste 960 CLERK BOARD OF SUPERVISORS Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: November 26, 2019 To: Clerk of the Board From: Maria Meza Department of Finance Subject: Affidavit — Stale Dated Treasurer Warrants Please find attached Affidavit to be included on the next available Board Agenda. • The attached item/s have been researched to ensure the warrant in question has not been cashed or previously re-issued. • The original warrant has a void/stale date/stop payment done. Please return the approved Affidavit to my attention Department of Finance, Suite 960. If you have any questions you may contact me at 602-506-1336 or maria.meza@maricopa.gov Thank you. Re: MVICTIM JENNIFER ZEHRBACH W#3 010039722 07/29/19 $916.59 D190 GAX1D 20-2311 RE:Inv# CR2018-159288-001- Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: iv 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 irint° "f Uenn'rFer Afa-end °bosh . (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 29-Jul-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/che to him/her in the sum of $ 916 . 59 43) Signed: (4) Not ease attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed mid sworn to before me this i9.tp,,,beic" 20 1-RI . k NO. se:!... 1 -1=11148-11,64M-2 / es 'Yti . NOTARY PUBLIC cc c•,It • — VL1 CV• 0 an. My,qonimission expires: .-:.1(13 4, OA." e •• (96(2.1) 4'0 .... .... (seal) 47COPA Warrant/Check Number 3010039722 (if known) (6) 29-Jul-2019 I rst Reason for original issue of Warrant/Check (8): O Payroll O For Services or Goods furnished O Treasurer's refund/payment Other: Victim Restitution FPIP CR2018-159288-001-1