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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: July 18, 2019 To: Clerk of the Board From: Maria Meza Department of Finance Subject: Affidavit — Stale Dated Treasurer Warrant Please find attached Affidavit to be included on the next available Board Agenda. • The attached item/s have been researched to ensure the warrant in question has not been cashed or previously re-issued. • The original warrant has a void/stale date/stop payment done. Please return the approved Affidavit to my attention Department of Finance, Suite 960. If you have any questions you may contact me at 602-506-1336 or maria.meza@maricopa.gov Thank you. Re: Treasurer Warrant W#862941 $384.92 Reduced Taxes 2016 Parcel 40003159 6/26/19 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is fon 0 Duplicate or E "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. RAFAELNCLINTON GILMORE (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 25-Aug-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 th -(3) Signed: 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 swpm to before me this )8-kk day of Z33) 2019 . NOTARY IPIDBLIC My commission expires: A0,20/ Warrant/Check Number 862941 (if known) (6) Original Date of Issue 25-Aug-2017 (if known) (7) Reason for original issue of Warrant/Check (8): GI Payroll CI For Services or Goods furnished Treasurer's refund/payment REDUCED TAXES 2016 PARCEL 40003159 El Other: FUND 100 BSA 2010 6/26/19 emailed to: rafaelagilmore@hotmail.com