Extracted text (via pymupdf_layout)
3752 characters
'CLEio", MARICOPA COUNTY :to AD OF SUPERVI'JCIFI'S Department of Finance MAPICOF A CO'It41 Y 301 West Jefferson, Ste 960 2019 JUN 12 PM 1: VI Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: June 12, 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. FYI - The check will be legally 21 days missing / outstanding on June 26, 2019 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 : 445 / D700 / Facilities Dept / MOUNTAIN STATES SPECIALTIES 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 Note: Numbers on this form correspond to COUNTY OF MARICOPA numbers on the Instruction sheet which is Page 2 of this form. MOUNTAIN STATES SPECIALTIES (1) being first sworn, upon oath deposes and says: Name/Claimant On or about 04 -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 $5,580.00 .( 3) Signed: /31fill PQ/ (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 /2 of ,ic 20 . NOTARY PUBLIC Victor Flores Notary Public My commission expires: Maricopa County, Arizona 6 ° --2 My Comm, Expires 6-27-2020 (seal) Warrant/Check Number 3010035263 (if known) (6) Original Date of Issue 04-Jun-2019 (if known) (7) JUN12 2019 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 YOUR SIGNAGE SPECIALISTS MOUNTAIN &TAM 8PECIALTIE8, INC. 4777 S. 32nd Street Phoenix, AZ. 85040 480.839.0751 Date: 6.12.2019 AFFIDAVIT/CLAIM FORM I, Bryan Billeter authorize Bryan Doyle, my Administrative Assistant to execute an affidavit for Mountain States Specialties, Inc. Yours truly, Bryan Billeter President Mountain States Specialties, Inc. 4777 S. 32nd Street Phoenix, AZ. 85040 P: 480.839.0751 F: 480.839.5360 C: 480.343.2656 D: 480.339.4301 E: bbilleter@mntstates.com COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZONA 3010035263 DATE 06-04-2019 91-2/1221 JPMorgan Chase Bank N.A Phoenix, AZ Five Thousand Five Hundred Eighty And 00/100 Dollars $5,580.00 PAY TO THE ORDER OF AMOUNT MOUNTAIN STATES SPECIALTIES IN 6125 S MAPLE AVE Void After TEMPE AZ 85283 365 Days For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV NOT NEGOTIABLE MARICOPA COUNTY DEPARTMENT OF FINANCE RETAIN THIS FOR PAYEE WARRANT NO. WARRANT DATE WARRANT AMOUNT YOUR RECORDS MOUNTAIN STATES SPECIALTIES IN 3010035263 06/04/2019 $5,580.00 INVOICE NUMBER DESCRIPTION PURCHASE ORDER NO. VOUCHER NO. AMOUNT 6226 4166-17-0006 BLACK CANYON APD DO D700 190000006796 190000000645 5,580.00