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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: October 28, 2019 To: Clerk of the Board From: Joyce Maurmann Department of Finance Subject: Affidavit — Replacement of stale dated Warrant Please find attached 1 Affidavit for a forged warrant to be included on the next available Board Agenda. • The attached item have been researched, the warrant in question was cashed by an unknown person, not the payee. • The replacement payment will be issued paid to the payee. Please call me at 506-1343 if you have any questions. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960. Thank you. Re: Tina Aguirre Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 1 1 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 Dade 2 of this form. Tina Aguirre (1), being first sworn, upon oath deposes and says: Name/Clatmant On or about 24-Sep-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 iissued to himiler in the sum of $ 2,000.00 .(3) Signed: (4) Note: Please attach a co4-)of the warranticheck if available and/or any other evidence that a warrant/check was originally issued. (5) Subspjb0 and orn to before me this 21 S4- day of 0e2:1-the-1,-- 20 11 . ARY PUBLIC Diana De Leon My commission expires: Maricopa Notary County, Public Arizona My Comm. Expires 0610-2022 (seal) CommiSSIon No. 548833 Warrant/Check Number 3010043973 (if known) (6) Original Date of Issue 24-Sep-2019 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll 0 For Services or Goods furnished 0 Treasurer's refund/payment Other: Victim Compensation: 1787802-1