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RECEIVED MARICOPA COUNTY Department of Finance NOV 26 2U19 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 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.nneza@maricopa.gov Thank you. Re: MVICTIM Kori Radell W#3010032248 04/26/19 $172.78 D190 GAX1D 19-38343 RE:Inv#00000052239K 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 bade 2 of this form. Kori RadeII (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 26-Apr-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 $ 172.78 .(3) Signed: 01\ (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. bscribed and sworn to before me this 7'74 day of 20 1 5. JACKI L JOBE NOTARY PUBLIC ARIZONA My co iqsion expires: My Maricopa Commission County Expires 4,74 014 December 5. 2021 (seal) 'i'!rrant/Check Number 3010032248 (if known) (6) Original Date of Issue 26-Apr-2019 (if known) (7) II Reason for original issue of Warrant/Check (8): CLERK, BOAi4D LI Payroll MARICOPA COUNTY D For Services or Goods furnished El Treasurer's refund/payment 0 Other: Victim Compensation Check: 1752802-1 Req 6-8