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r C MARICOPA COUNTY II " 4 Sui , E • , • : Department of Finance 301 West Jefferson, Ste 960 2019 OCT 16 li,‘; I Phoenix, Arizona 85003 1-14Ad 0eA rl 44'it INTEROFFICE MEMORANDUM Date: October 16, 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 : 991 / Dept : 690 / FLOOD CONTROL / MOBILE BOUNDARY HYDRAULICS 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 PtR14-MsnR Note: Numbers on this form correspond to COUNTY OF MAR-IC—GP-A GI)IZLCI\YCI) numbers on the Instruction sheet which is pane 2 of this form. MOBILE BOUNDARY HYDRAULICS (1), being first sworn, upon oath deposes and says: —19ar'ne7CTaimant On or about 26-Jun-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 $ 900,00 .(3) Signed: a. (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 IL) I Okri-4--) day of Se mber20 \9 . NOTARY PUBLIC TORI MBAR Notary Public - Arkansas My commission expires: Commission Garland # County 12706687 Ecb. 4 My Commission Expires Feb 28, 2029 (seal) Warrant/Check Number known) (6) 13010037356 Original Date of Issue 26-Jun-2019 (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll O For Services or Goods furnished O Treasurer's refund/payment Other: presumed lost in the mail MOBILE BOUNDARY HYDRAULICS, PLLC P.O. Box 20486 Hot Springs, AR 71903-0486 Tel. 601-954-2390 mbh2o@aol.com October 11,2019 Maricopa County Department of Finance A_ccoutus i'ayabie Attn: Walter Chang 301 W Jefferson Street Suite 960 Phoenix, AZ 85003 SUBJECT: AFFIDAVIT/CLAIM FORM I , Mr. William A. Thomas, executed an affidavit for MOBILE BOUNDARY HYDRAULICS, PLLC I am the president of Mobile Boundary Hydraulics, PLLC. There is no one to authorize me to take action on behalf of this company. In fact, I am the only person working in this company at the present. All others have retired. Yours truly, William A. Thomas, President, Mobile Boundary Hydraulics, PLLC Enc AS