Extracted text (via pymupdf_layout)
5626 characters
▪ MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 rea INTEROFFICE MEMORANDUM C= S 7-'7= raz -n 71 47.1 0 CO 00 0 'It Date: February 8, 2019 >. tit rrl re- To: Clerk of the Board Tz• 0 71 .< CD • • —4 (1) From: Marcia J. Clark -< Department of Finance Lc, Subject: Affidavit — PROVIDERS KOREA 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- General Dept. 560-Public Defense Services PRCPD1 195NED000417 r illp 1 i 0 I -R---HrigAC 18. 16 11 -A A 1- (}) 02)776-6926,777-6926 P'&171 A141_A-1 1=11 (A2-- ) 02)779-6926 Registered No. 2019- 850 NOTARIAL CERTIFICATE JUNG HYUN PAIK NOTARY OFFICE. 16, Sejong-daero 18-gil, Jung-gu, Seoul, Korea 210mm X 297mm A-141g Aii*ril 18V 16 0 0 Apqr._± ( -1§1-) 02)776-6926,777-6926 pr,g1 71421.A1>1] (g-112-) 02)779-6926 -W-3-1- 2019 LA z11 8501. Registered No. 2019 - 850 NOTARIAL CERTIFICATE JUNGNAM CHI ;•_111 ,9 011 71A1.V__ aum..-01 personally appeared before me and admitted his(her) subscription to the -;-_- 0 1,1-302- *-9,1-ql 1?1_11 011A1 1 RfA1A1 011 attached APPLICATION FOR DUPLICATE 47171-Al t _ od OR STALE-DATED WARRANT/CHECK AFFIDAVIT/CLAIM FORM. 2019k1 024S OTV This is hereby attested on this AP+1 --±-1 'Zi*ttr-t. 7th day of Feb. 2019 at this office. 1:7(11] Name of the office 41?-± JUNG HYUN PAIK NOTARY OFFICE. 411 Belong to Seoul Central AI 1 R. Al District Prosecutor's Office Al a 4ig. 18V 16 Address of the office 16, Sejong-daero 18-gil, Jung-gu, Seoul, Korea o 0 01 -t- ure of the Nbtary Pupil 1 -11 JUNG HYUN 41991:11 7i -8i-01 This office has been authorized by the 2018k4 02 -V 05V Ei Minister of Justice, the Republic of 7 1- 'g 9X Korea, to act as Notary Public Since 5, Feb. 2018 Under Law No.199. 210mm X 207mm Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 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 page 2 of this form. PROVIDERS KOREA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 21-Dec-2018 (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 $4,025.00 .(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 sworn to before me this day of 20 NOTARY PUBLIC My commission expires: (seal) Warrant/Check Number 3010022757 (if known) (6) Original Date of Issue 21-Dec-2018 (If known) (7) APPRii% Reason for original issue of Warrant/Check (8): El Payroll 0 For Services or Goods furnished LI Treasurer's refund/payment Other: LOST WARRANT Providers Korea Risk Management Consulting Maiicopa County Department of Finance Attn: Accounts Payable —Marcia Clark 301 W Jefferson, Suite 960 Phoenix, AZ 85003 USA February 7, 2019 Dear Ms Clark, This is to state and confirm that the undersigned, Jungnam Chi, is the representative of Providers Korea and is fully authorized to sign all corporate legal documents including the attached Affidavit/Notice of Claim form. Your cooperation as such in processing the application would be greatly appreciated. Jiingnam Chi Representative Providers Korea am 0900:59 12/24/2018 date number number 210100-200-2000-2768-20198-4100-- sent voucher orig: number fund: num: date pay details claim low PO sub dept date Posting Invoice: Invoice Paid Positive Agency Agency Agency Agency Agency Agency Agency Account am 12:00:00 3010022757 MCT0000000107 12/21/2018 Stopped None 0 0.00000 Korea LI 2 LI am pay: rate Payee Providers 0%01159 header number flag: reason: positive reconcile interest interest lines date for for registered: days Amount 4,025.00 3010022757 Warrant General Warrant Holder Issued Status: Exception Exception Queued Locked Registered Date of No Annual Warrant El 12/24/2018 • • date number number 210100-200-2000-2758-20198-4100-- sent details voucher claim orig: number fund: num: of still No date: date: pay low PO sub dept number: amount you Posting Invoice Invoice Paid Positive Agency Agency Agency Agency Agency Agency Agency Account the that warrant for warrant on am', a Yes am payment 12:00:00 Stop 12:0Ct00 stop not do Et Confirmation to '12/21/2018 so MC70000000107 0 wen applied, 3010022757 12/21/2018 Issued None 0.00000 Korea you that on: issued be will El Li pay: Payee Providers contirm fees header number flag: reason: positive reconcile interest rate interest Lines Please 3010022757'; 4.025.00?' Bank Note possess. date for for registered: days Amount 4,025.00 3010022757 Warrant General Warrant Holder Issued Status: Exception Exception Queued Locked Registered Date of No Annual Warrant El • •