08.06.19 REPLACEMENT WARRANT ATTACHMENT.PDF

Applicaton for a Devlicate or Stale-Dated Warrant/Check
Affidavit/ Claim Form
This zpplication is for: El Duplicate or 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
bacse_2 of this form.
(1) ; being first sworn, upon oath deposes an ys:
N ek,iaimant
On or about See attachment (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 $ See attachment . (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 s before me this day of 20
Pablo Mayorga
My cop ission expires: Maricopa Notary County, Public Arizona
ii My Comm. Expires 7-8Aaq
Warrant/Check Number
(if known) (6)
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8):
El 1),roll
le-For Services or Goods furnished
E1 Treasurers efund/payment
Other:
AMBIANCE OBJECTS VIC ID 25817

Summary of Unclaimed Funds
Warrant # Issue Date Vendor Name Warrant Amount
00360005995 9/8/2015 AMBIANCE OBJECTS $51.32
00360008588 10/8/2015 AMBIANCE OBJECTS $70.00
00360015344 1/6/2016 AMBIANCE OBJECTS $100.00
00360023212 4/11/2016 AMBIANCE OBJECTS $75.00
00360025387 5/4/2016 AMBIANCE OBJECTS $28.68
Total $325.00

Ambiance & Objects
1210 E. Indian Sckool Rd
Joy Lambard - owner
480)
a Ak_k
'6n

Christian Kristine
VriaMaNiuneimame.emegidainkain
From: FIN AccountsPayable <FINAccountsPayable@maricopa.gov >
Sent: Friday, August 2, 2019 2:01 PM
To: Christian Kristine; FIN AccountsPayable
Subject: RE: Affidavit review - Ambiance Objects $325.00
Attachments: Affidavit Ambiance Objects 322.00.pdf
Hi Kristine,
the dom.
Bank Account Check! EFT Number Check / EFT Amount Document ID s tatus Clear
1000 000000360005995 $51.32 State Dated 10/2
• 0D0 .r.00 ,:-.)00260008588 $70.00 l a }e Dated 11/1
000 000000.360015344 $100.00 stale 02/C
1000 0000003600232 12 $75 .0{) Stale Dased 05/2
000000.7.!600253G1 6e, Staie
IN ev Neyi Last
Thanks,
Joyce Maurniann
Accounts Payable Supervisor
Maricopa County Department of Final -,
Phone: (602) 506-1343 I Fax: (602) 5... 39
/P Phone: (602) 506-39
1 -- Matit-rriann(c-bniari .]•• I .H.:@maricopag:
Website: http://wwvv.maricopa.qov/finance/
From: Christian Kristine [mailto:chriskOl@mcao.maricopa.gov]
Sent: Friday, August 2, 2019 10:31 AM
To: FIN AccountsPayable <FINAccountsPayable@maricopa.gov >
Subject: Affidavit review - Ambiance Objects $325.00
The attached affidavit is greater than 2 years old. The BOS requires the department to request the reissuance of these.
Can you please review the paperwork to ensure everything is in order prior to MCAO submitting to the BOS for approval
to reissue.
If you are able to supply an answer before mid-Tuesday, we will be able to place this on the next BOS agenda.
Thanks,

4catien for a 117[Micat or tA74 Dated INE- rrrant/Chcck
Affidavit/CI ! Form
This application is for: 0 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
oaae 2 of this form.
Natalia R Gonzalez (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 17-May-2017 (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 $ 222.47 .(3)
Signed: (4)
Note: . Pleasejttach 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 day of cloil-e 2o/7 .
OFFICIAL SEAL
My commission expires: JASPREET BRAN
/2,69 Notary NW- Stale of Arizo"na
CP- MARICOPA COUNTY (seal)
My Comm. Expirm Aug, 20, 2021
Warrant/Check Number see attached
(if known) (6)
Original Date of Issue 17-May-2017
(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: Victim Compensation: VC2014021855-1

Grant Full Case # Vendor Name Warrant No Total
VC2014021855-1-2 NATALIA R GONZALEZ 000000370024356 80.00
VC2014021855-1-3 NATALIA R GONZALEZ 000000370024357 68.31
VC2014021855-1-4 NATALIA R GONZALEZ 000000370024355 40.00
VC2014021855-1-5 NATALIA R GONZALEZ 000000370024358 34.16

Christian Kristine
n.fea":6
From: FIN AccountsPayable <FINAccountsPayable@maricopa.gov >
Sent: Wednesday, July 31, 2019 3:12 PM
To: Christian Kristine; FIN AccountsPayable
Cc: Teresa Finley (FIN)
Subject: RE: Affidavit review - Gonzalez $222.47
Attachments: Affidavit Gonzalez $222.47.pdf
Hi Kristine
.; is fir:22 clatc V
Bank Account : Document Code :
Check I EFT Number: 024356,*37002, Doc Dept :
Check / EFT Amount : Document ID:
Check / EFT Issue Date : Cleared Date : U-1
Last Action Date : Status :
Bank Account Check I EFT Number Check I EFT Amount Document ID Status Cleared Date
1000 000000370024355 $40.00 Stale Dated 06/01/2018
1000 000000370024355 $80.00 Stale Dated 06,01/2018
1000 000000370024357 $68_31 87ale Dated 0610112018
1000 000000370024358 $34_13 Stale Dated 00/01/2018
First Prey Nexl Last
Joyce ft n
Accow ..! e Supervisor
Maric ty Department of Finance
Phoir:..602) 506-1343 Fax: (602) 506-3439
A/P F h.:ne: (602) 506-3439
ossl • . a_pOrn -icow
Website: http://www.maricopa.00v/finance/
1

From: Christian Kristine [mailto:chrisk01@mcao.maricopa.gov]
Sent: Wednesday, July 31, 2019 8:49 AM
To: FIN AccountsPayable <FINAccountsPayable@maricopa.gov >
Subject: Affidavit review - Gonzalez $222.47
The attached affidavit is greater than 2 years old. The BOS requires the department to request the reissuance of these.
Can you please review the paperwork to ensure everything is in order prior to MCAO submitting to the BOS for approval
to reissue.
Thanks,
Krbstinve/
Kristine Christian I Maricopa County Attorney's Office I Finance Manager
Desk: (602) 506-8337 I Mobile: (602) 832-9569 I Fax: (602) 506-1595 I Email:
2