011619 DUPLICATE WARRANTS 21.PDF

MARICOPA COUNTY Ji .,u .
Department of Finance MARICOPA COUNi Y
301 West Jefferson, Ste 960 2019 JAN -2 All 9: 33
Phoenix, Arizona 85003 tod,aelot''\
INTEROFFICE MEMORANDUM
Date: December 26, 2018
To: Clerk of the Board
From: Nadine Higuera
Department of Finance
Subject: Affidavit —Replacement of destroyed 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 506-1354 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re:
Fund 232/D640 Transportation

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.
SALT RIVER PROJECT (1), being first sworn, upon oath deposes and says:
Nameiciaimant
On or about 20-Nov-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 $5,349.22 .(3)
Signed: ) AM--- C- , A ) OA (A )SC-P (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
Subscr,ibed and sworn to before me this I day of Ift Csi-in 6 -er 20 (a.
II++ 111111
• 1J(trjI/1/11-11,:cnn
trAtiiCcipI ..001111117,
Iviz commission expires: 11III01tsvI
Mac 3 , ZOZZ_ (seal)
Warrant/Check Number 3010019750
(if known) (6)
Original Date of Issue 20-Nov-2018
(if known) (7)
Reason for original issue of Warrant/Check (8):
El Payroll
CI For Services or Goods furnished
El Treasurer's refund/payment
Other: DESTROYED