Extracted text (via pymupdf_layout)
2634 characters
MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 96 JUN 28 P1112: 17 Phoenix, Arizona 85003 1-‘eAS INTEROFFICE MEMORANDUM Date: June 28, 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: 100 / Dept: D470 / non-departmental / Company: HAVEN OF SCOTTSDALE LLC Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 1=I Duplicate or 1=1 Stale-Dated (definitions itre on page 2) STATE OF ARIZONA Note: Numbers on 6118 oPm correspond to COUNTY OF MARICOPA numbers on the instrUction sheet Which is paue 2 of this form HAVEN OF SCOTTSbALE being first sworn, Upon oath deposes and-iays: Nameiciaimani On or abOLit ° 1-MaY-2° 19 000(2) a warrant/check was issued to the above named person/tritity 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 b4it8Ued tojNiii/het iln the sum of $5,237.45 .(3) Signed: #1 (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 day of JiJ 20 Salgaao Notary Public Maricopa County, Arizona My commission expires: My Commission Expires 10/ 2-e/2- I (seal) Warrant/Check Number 13010032800 (if known) (6) Original Date of Issue 01-May-2019 (If knoWn) (7) A p teb ire n Reason for original issue of Warrant/Check (8): LI Payroll or Services or Goods furnished LI Treasurer's refund/payment ri other: warrant presumed lost in the mail haven health riLUTT'JDAI June 20, 2019 Dear Board of Supervisors, I, Dustin Schaffer, authorize Teena Martin to execute an affidavit for Haven of Scottsdale LLC. Yours truly Dusti SL-14ffer Executi4Director at Haven of Scottsdale