112019 CITY OF PHOENIX SEWER & WATER.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: October 22, 2019 REC VED
To: Clerk of the Board OCT 2 2 2019
MARICOPA COUNTY
From: Walter Chang CLERK BOARD OF SUPERVISORS
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 : 255 / Dept : 700 / FACILITIES / CITY OF PHOENIX SEWER & WATER

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
4C/1 \'I pacie 2 of this form.
City of Phoenix Watcr & Sewer (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 29 -May-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 request § tat a replacement
warrant/check be issued to him/her in the sum of $20,480.00- 60 .(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 Ja day of 06010,e4.- 20 19 .
LL4
C2-e-ev
NOTARY PUBLIC MARICELA RUIZ
NOTARY PUBLIC, ARIZONA
MARICOPA COUNTY
My commission expires: My Commission Expires
1)01 cljt, OA 0 March 22, 2020 (seal)
Warrant/Check Number 3010034801
(if known) (6)
Original Date of Issue 29-May-2019
(if known) (7)
Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISOf
MARICOPA COUNTY
O Payroll
For Services or Goods furnished water & sewer services
O Treasurer's refund/payment
O Other:

City of Phoenix
WATER SERVICES DEPARTMENT
CUSTOMER SERVICES DIVISION
October 22, 2019
I, Guadalupe Warren, do authorize Maricela Ruiz to execute an affidavit on behalf of the City of
Phoenix Water and Sewer Services for a replacement check to be issued for services performed.
The initial check was issued on May 29, 2019 and has not been cashed by the City or Phoenix
nor returned to the Maricopa County Department of Finance as confirmed by the Finance
Manager for Maricopa County Facilities Mgnnt. Dept.
fal 11.1
Guadalupe Warren
City of Phoenix — Water Collections Supervisor
251 W Washington St — 3 rd Floor
Phoenix AZ 85006
602-256-3393
305 West Washington Street, Suite 200 • Phoenix, Arizona 85003-2102 o 602-262-6251 • FAX: 602-534-3695
Recycled Paper

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010034801
DATE
05 -29 -2019 91-2/1221
JPMorgan Chase Bank N.A
Phoenix, AZ
Twenty Thousand Four Hundred Eighty And 80/100 Dollars
$20,480.80
PAY TO THE ORDER OF AMOUNT
CITY OF PHOENIX SEWER & WATER
PO BOX 29100 Void After
PHOENIX AZ 85038-9100 365 Days
For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR PAYEE WARRANT NO. WARRANT DATE WARRANT AMOUNT
YOUR RECORDS
CITY OF PHOENIX SEWER & WATER 3010034801 05/29/2019 $20,480.80
INVOICE NUMBER DESCRIPTION PURCHASE ORDER No. VOUCHER NO. AMOUNT
19471100000519 ACCT # 1947110000 ' GAX10 0700 190000042414 579.94
190000042414
80421100000519 ACCT #8042110000 vr GAX1D D700 190000042415 284.51
190000042415
70421100000519 ACCT #7042110000 17 GAM D 0700 190000042417 198.32
190000042417
60421100000519 ACCT #6042110000 Vi GAX1D D700 190000042418 44.73
190000042418
11571100000519 ACCT #1157110000 '',/ GAX1D D700 190000042419 39.30
190000042419
21184000000519 ACCT # 2118400000 / GAX1D D700 190000042420 564.23
190000042420
21184000000519 ACCT # 2118400000 \o/ GAX1D 0700 190000042420 960.72
190000042420
01184000000519 ACCT # 011840000D Vi. GAX1D D700 190000042423 333.42
190000042423
82184000000519 ACCT #8218400000 V GAX1D 0700 190000042424 2,194.36
190000042424
23184000000519 ACCT # 2318400000 I GAX1D 0700 190000042426 2,079.20
190000042426
92184000000519 ACCT #9218400000 j GAX1D 0700 190000042428 3,519.92
190000042428
13184000000519 ACCT # 1318400000 V GAX1D 0700 190000042429 505.71
190000042429
93184000000519 ACCT #9318400000 / GAX1D D700 190000042431 1,250.69
190000042431
83184000000519 ACCT # 8318400000 V/ GAX1D D700 190000042433 146.21
190000042433
51184000000519 ACCT #5118400000 / GAX1D D700 190000042435 192.51
190000042435
27442100000519 ACCT # 2744210000 N./ GAX1D 0700 190000042437 168.07
190000042437
31184000000519 ACCT # 3118400000 / GAX1D D700 190000042439 469.59
190000042439
90184000000519 ACCT # 9018400000i GAX1D 0700 190000042440 115.70
190000042440
24184000000519 ACCT # 2418400000 / GAX1D 0700 190000042444 1,346.64
190000042444
24184000000519 ACCT # 2418400000 1 GAX1D D700 190000042444 402.24
•sool• —

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010034801
DATE
05-29-2019 91-2/1221
JPMorgan Chase Bank N.A
Phoenix, AZ
VOID VOID VOID VOID VOID VOID VOID VOID VOID
$ VOID
PAY TO THE ORDER OF AMOUNT
CITY OF PHOENIX SEWER & WATER
PO BOX 29100
Void After
PHOENIX AZ 85038-9100 365 Days
For Questions - 602-506-1379 or email AP@IvIAIL.MARICOPA_GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR PAYEE WARRANT NO. WARRANT DATE WARRANT AMOUNT
YOUR RECORDS
3010034801 05/29/2019 $ VOID
INVOICE NUMBER DESCRIPTION PURCHASE ORDER NO. VOUCHER NO. AMOUNT
42184000000519 ACCT # 4218400000j GAX1D 0700 190000042446 1,379.37
190000042446
22184000000519 ACCT #2218400000 I GAX1D D700 190000042447 1,137.18
190000042447
61184000000519 ACCT #6118400000 i GAM D 0700 190000042448 261.99
190000042448
14184000000519 ACCT #1418400000 I GAX1D 0700 190000042449 1,625.37
190000042449
14184000000519 ACCT #1418400000/ GAX1D D700 190000042449 485.50
190000042449
04184000000519 ACCT # 0418400000 ‘./ GAX1D 0700 190000042451 54.13
190000042451
04184000000519 ACCT #0418400000 I GAX1D 0700 190000042451 16.17
• 190000042451
52184000000519 ACCT # 5218400000 I GAX1D 0700 190000042453 125.08
190000042453