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CL ER MIAR P OF SUPER YESOR'S irk) MARICOPA COUNTY HAR1COPA COUNIV Department of Finance 2018 NOV PdA-1 1 301 West Jefferson, Ste 960 18 AN 11:52 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM MEMORANDUM Date: November 18, 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: 100 / Dept: 520 / Public Defender / Company: LABORATORY CORP OF AMERICA Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Eli 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. LABORATORY CORP OF AMERICA (1), being first sworn, upon oath deposes and says: 'l—neC-ff'il ar rian On or about 21 -Sep -2018 (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 $605.00 .(3) Signed: CL:.,/ it/7 /.7 6 / (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a wan-ant/check was originally issued. (5) Subscribed and sworn to before me this day of AfDlie-Min 20 /9 NOTARY PUBLIC PATRICIA D SPRAGUE My commission expires: NOTARY PUBLIC ALAMANCE COUNTY, NC (seal) My CommisOon Expires 842022 Warrant/Check Number 3010015571 (if known) (6) Original Date of Issue 21-Sep-2018 (if known) (7) Reason for original issue of Warrant/Check (8): D Payroll D For Services or Goods furnished El Treasurer's refund/payment Other: presumed lost in the mail / check went stale K-4 E 1 7,--= • ." -7— E &.7.- •7:. =_ 1. Laboratory Corporation of America — 11/7/19 I, Diane P. Holt, LabCorp DNA Customer Service Manager, authorize Teresa R. Clifton, LabCorp DNA Supervisor, to execute the affidavit/notice of claim form attached. Please send the payment in the amount of $605 for DNA testing, LabCorp case # COY-044396 directly to me at the address listed below. Regards, c34. Diane P. Holt LabCorp DNA Customer Service Manager 1440 York Ct Burlington, NC 27215 Ph. 336-436-7552 Email holtd1@labcorp.com