011619 DUPLICATE WARRANTS 24.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: January 2, 2019
To: Clerk of the Board
From: Maria Meza
Department of Finance
Subject: Affidavits — Replacement of Lost Warrants
Please find attached Affidavit for lost warrant to be included on the next available Board
Agenda.
• The attached item/s have 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 506-1336 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: MUTT JOYCE SCHULZ
W#3010018039 $10.00
D790 GAX1D 19-13830 $10.00
Inv # R18-597641
Fund-572 Dept-D790 ANIMAL CARE & CONTROL

12/12/18
Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1 Duplicate or CI 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
bade 2 of this form.
MUTT Joyce Schulz (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 24-Oct-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 shov,vn, is due and owing, and the applicant requests that a replacement
warrant eck be issued 43)
'77)
Signed: (4)
No*: Pkkase attach A copy of the 'check if available and/or any other
evi ce_that a warthpircheck was origingly-iksued,
(5) Subscribed and sworn tp-before me this g\c.)kt"-- day ofDeter,ts4riz. 20
NOTARY PUBLIC
BRADEN SMARTT
My commission expires: Notary Public - Arizona
01- Commission Maricopa County # 549867 (seal)
My Comm. Expires Jul 25, 2022
Warrant/Check Number I•III
(if known) (6) 3010018039
Original Date of Issue 24-Oct-2018
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll tto
HIK, BOARD OE 5 UPERVISOHS
O For Services or Goods furnished MARICOPA COUNTY
O Treasurer's refund/payment
Other: D790 GAX1D 19-13830 Refund- pet exempt