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RECEIVED ' MARICOPA COUNTY Department of Finance NOV 2 6 2019 301 West Jefferson, Ste 960 MARICOPA COUNTY Phoenix, Arizona 85003 CLERK BOARD OF SUPERVISORS 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 A genda. • The attached item/s have been researched to ensure the warrant in question has not been cashed or previousl y re-issued. • The original warrant has a void/stale date/stop pa yment done. Please return the approved Affidavit to my attention Department of Finance, Suite 960. If you have any q uestions you may contact me at 602-506-1336 or maria.meza@maricopa. gov Thank you. Re: MVICTIM SHARON AL ES WAD W#3010041833 06/19/11 $243.34 D190 GAX1D 20-5987 RE:Inv# 00000053831K Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or El 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 Page 2 of this form. Sharon Al Eswad (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 27 -Aug -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 him/her in the sum of $774.62 .(3) Signed: &toy ) CUL_ E9 (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 0(0 day of kJ o VErA c 20 1 9 . 14 Jeremy u Smltfl NO AR PUBLIC Notary Public Maricope County, Arizona My commission expires: My Comm. Expires 01-13-2023 of I 1.3 Commission No. 657744 al) Warrant/Check Number 3010041833 (if known) (6) Original Date of Issue 27-Aug-2019 (if known) (7) Reason for original issue of Warrant/Check (8): III Payroll CLERK, MARICOPA BOARD --uPERVISORS OLINTY El For Services or Goods furnished El Treasurer's refund/payment Other: Victim Compensation Check: 1661411-1- rqst 10