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CLERK BOARD OF SUPERVISOR'S MARICOPA COUNTY MARICOPA COUNT Y Department of Finance 2019 JAN 30 AM 8: 0 I 301 West Jefferson, Ste 960 wpe ‘6Lir lod Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: January 29, 2019 To: Clerk of the Board From: Beth Brown Department of Finance Subject: Affidavit — Replacement of Lost Warrant Please find attached affidavit for lost warrant to be included on the next available Board Agenda. • The attached item has 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 call me at 506-1329 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: SAUL LOPEZ 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 pace 2 of this form. Saul Lopez (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 02-Aug-2018 (ciate)(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 $ 3,201.77 -(3) Signed: ../SCUIQ in.c4o .A . (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) Subscrib n s or to before me this .1-)lit day of -1iDeCetit46f0 JP DARDEN NOTARY PUBLIC for the MgrtynTissioaAnires: State of Montana (—tin Residing at Bozeman,Jv1ontna I My Commission E June 12,2022 Warrant/Check Number 57130C /000003010011849 (if known) (6) Original Date of Issue 02-Aug-2018 if known) (7 A V Reason for original issue of Warrant/Check (8): 2019 DATEA_ 1 D Payroll 0 For Services or Goods furnished LI Treasurer's refund/payment Other: Never received check v ( -7 000 6 4 rcp4 z Virtm CO pit) eh S aKor• rt&-f- 3 "-j JAN 1 6 2019 I Ec ct cciAt- -30‘ 9 (voi .7/2 COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER ••IINi PHOENIX, ARIZONA 3010011849 Co ,r4+0I4*If 461 DATE 08 -02 -2018 91-2/1221 JPMorgan Chase Bank N.A Phoenix, AZ Three Thousand Two Hundred One And 771100 Dollars $3,201.77 PAY TO THE ORDER OF AMOUNT Saul Lopez Void After 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 VICTIM WITNESS 3010011849 08/02/2018 53,201.77 INVOICE NUMBER DESCRIPTION PURCHASE ORDER NO. VOUCHER NO. AMOUNT 00000057131C VC2017000644-1-rqst2 GAX1D D190 190000003019 1,692.42 190000003019 00000057130C VC2017000644-1-rqst3 GAX1D D190 190000003019 1,509.35 190000003019