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CLERK 30ARD OF SUPERVISOR'S MARICOPA COUNTY MARICOPA COUNTY Department of Finance 2019 JAN 30 AM 8: 01 301 West Jefferson, Ste 960 tL \\Ps* q Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: January 29, 2019 To: Clerk of the Board From: Beth Brown Department of Finance Subject: Affidavit — Replacement of Stale Dated Warrant Please find attached affidavit for Stale Dated 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: KAREN KONNOFF Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This appfication is for: [ Duplicate or %1 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 Dale 2 of this form. Karen Konnoff (1), being first sworn, upon oath deposes and says: Name/Craimant I t ie On or about 05-ep S -201 7 , (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 $ 12-42 .9 61 4 30. WI (ICI' 1'1? i(3) i 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,b4ore me this c; :re day of /4 CATHY NOGHREHCHI Notary Public - Arizona Maricopa County My Comm. Expires Apr 30, 2021 1 'A/arrant/Check NIUMber I -(fif known) (6) I 0380004765 Original Date of Issue 05-Sep-2017 Of known) (7) Reason for original issue of Warrant/Check (8): O Payroll O For Services or Goods furnished O Treasurer's refund/payment Other: Victim Compensation Check 1. (Dow.4-b. -IN (-V) q ONQ gl7 COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZONA 380004765 DATE 09-01-2017 91-2/1221 JPMorgan Chase Bank N.A Phoenix, AZ One Hundred Fifty Six And 98/100 Dollars $156.98 PAY TO THE ORDER OF AMOUNT KAREN KONNOFF 301 W Jefferson 9th Floor PHOENIX AZ 85233 Void After 365 Days 41-firZ-Tt 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 000000380004765 09/01/2017 $156.98 INVOICE NUMBER DESCRIPTION PURCHASE ORDER NO. VOUCHER NO. AMOUNT 000000534440 VC2015000513-1-rqst4 GAX1D D190 180000006197 30.19 180000006197 000000534450 VC2015000513-1-rqst3 GAX1D D190 180000006197 126.79 180000006197