LOONEY.PDF

MARICOPA COUNTY
Department of Finance 2819 AUG 12 AN 10: 2
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: August 12, 2019
To: Clerk of the Board
From: Nadine Higuera
Department of Finance
Subject: Affidavit — Replacement of forged warrant.
Please find attached 1 Affidavit for a forged warrant 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 506-1354 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 D560: / S Marie Looney

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: l 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
Page 2 of this form.
S MARIE LOONEY (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 17-Jul-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/twin the sum of $2,890.00 .(3)
Signed: (4)
Note: Pleas'e attach`a—coprof 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 t2 day of 4aguoi--- 20 19 .
NOTARY/PUBLIC
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My commission expires: (giliijEJS.;;,„ Notary JAVIER Public PALMA - Arizona
..41 e/5 . Z.5; 7,02Z Commission Maricopa County # 550639 (seal)
My Comm. Expires Aug 25, 2022
Warrant/Check Number 3010038894 -
(if known) (6)
Original Date of Issue 17-Jul-2019
(if known) (7)
C=3
Reason for original issue of Warrant/Check (8): er.74
C-
LI Payroll C')
R.;
0 For Services or Goods furnished
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111 Treasurer's refund/payment
Other: forged check r