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5 MARICOPA COUNTY Department of Finance 2019 APR 1 1 PM f:37 °I 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: April 11,2019 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — LEE UNDERWOOD Please find attached 1 Affidavit for stale dated 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 warrant is lost. Please call me at 506-7291 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- D570 PUBLIC ADVOCATE - GAX1D 19*25315 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: VI 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. LEE UNDERWOOD (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 24 -Jan -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 eçl) to him/her ire sum of $750.00 .(3) II Signed: It/q",07),7 (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 20 / . NOTARY PUBLIC Joshua Wald Notary Public My commission xpires: Maricopa County, Arizona y I Le My Comm. Expires 01-16M) Warrant/Check Number 3010024998 Of known) (6) Original Date of Issue 24-Jan-2019 (if known) (7) Reason for original issue of Warrant/Check (8): tfr 0 Payroll IARICOPA COUNTY 111 For Services or Goods furnished 0 Treasurer's refund/payment Other: LOST WARRANT (FUND 100 D570 PUBLIC ADVOCATE GAX1D 19*25315) am 0900:11 1/25/2019 date: number: number: number. num: 210100-200-2000-2768-20198-4100-... date: sent pay details voucher claim orig: low PO fund: sub dept Posting Invoice: Invoice date: Paid Positive Agency Agency Agency Agency Agency Agency Agency Account ll Attachments Attachments am 12:00:00 7 Print Setup Status Status 3010024998 MCT0000000107 1/24/2019 Stopped 0 0.00000 None UNDERWOOD Warrant New pay: Warrant header number, flag: reason: positive reconcile: interest rate: Lines Payee LEE date: for for registered: days interest Amount 750.00 Maintain 3010024998 Warrant General Warrant Holder: Issued Status: Exception Exception Queued Locked Registered Date of No Annual Warrant El A