Extracted text (via tesseract_tsv)
5851 characters
MARICOPA COUNTY SUPEE 5
SBARD OF VIS0: nr
Department of Finance HARICOPA COUNTY
Ss
301 West Jefferson, Ste 960 :38 reo
pig NOY a -8 PHIZ
: .
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: November 8, 2018
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.
e The attached item has been researched to ensure the warrant in question
has not been cashed or previously re-issued.
e 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: Animal Medical Center
Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit /Claim Form
This application is for: bA Duplicate or LJ 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
pade 2 of this form.
Lu (Wetle Lice (1), being first sworn, upon oath deposes and says:
_
aiman on behalf of Animal Medical Center
On or about _See attachment (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 $_See attachment (3) £
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) and before me this day of (Af. 20/%..
sworn nto a
re,
NOTARY PUBLIC
Gunesio Flores Horandes
(eax Notary Public
My commission expires: ET) sy comes trae aeons
2 -29—| g = Commission No. 465174 (seal)
Moremi. | 28000 4% 1x
“fod
Original Date of Issue _
(if known) (7) {( | € fife
Reason for original issue of Warrant/Check (8): Dp PRO Vv ED
O Payroll | Tal
4 1 33 1 5 0 447 2632 1000 45 -1
5 1 33 1 5 1 447 2639 38 37 37.016483 C
5 1 33 1 5 2 517 2637 68 40 96.480881 For
5 1 33 1 5 3 599 2636 175 41 96.595863 Services
5 1 33 1 5 4 790 2646 44 30 96.526878 or
5 1 33 1 5 5 849 2634 132 42 93.289574 Goods
5 1 33 1 5 6 997 2632 249 43 17.870874 furnished__,
5 1 33 1 5 7 1440 2632 7 8 68.929718 :
4 1 33 1 6 0 446 2722 665 51 -1
5 1 33 1 6 1 446 2727 38 38 62.947575 O
5 1 33 1 6 2 514 2722 238 42 0.000000 Treasurers
5 1 33 1 6 3 770 2722 341 51 90.951477 refund/payment
2 1 34 0 0 0 414 2718 1507 307 -1
3 1 34 1 0 0 414 2718 1507 307 -1
4 1 34 1 1 0 414 2718 1507 219 -1
5 1 34 1 1 1 414 2792 233 145 60.650757 ower
5 1 34 1 1 2 753 2771 142 109 17.770710 Vteyl
5 1 34 1 1 3 961 2771 193 125 20.532484 ante
5 1 34 1 1 4 1214 2764 310 99 4.059544 reAMlAW
5 1 34 1 1 5 1556 2789 66 61 54.943523 Se
5 1 34 1 1 6 1625 2718 296 150 42.187843 ene
4 1 34 1 2 0 702 2911 1139 114 -1
5 1 34 1 2 1 702 2956 165 69 32.553146 Cad
5 1 34 1 2 2 928 2957 49 61 6.449070 18
5 1 34 1 2 3 989 2947 186 70 0.000000 e143
5 1 34 1 2 4 1263 2932 178 68 0.000000 A199
5 1 34 1 2 5 1563 2915 142 76 87.187843 Fund
5 1 34 1 2 6 1749 2911 92 60 72.894226 Wo
2 1 35 0 0 0 349 2266 1948 12 -1
3 1 35 1 0 0 349 2266 1948 12 -1
4 1 35 1 1 0 349 2266 1948 12 -1
5 1 35 1 1 1 349 2266 1948 12 95.000000
2 1 36 0 0 0 344 1772 20 611 -1
3 1 36 1 0 0 344 1772 20 611 -1
4 1 36 1 1 0 344 1772 20 611 -1
5 1 36 1 1 1 344 1772 20 611 95.000000
2 1 37 0 0 0 2295 1852 31 524 -1
3 1 37 1 0 0 2295 1852 31 524 -1
4 1 37 1 1 0 2295 1852 31 524 -1
5 1 37 1 1 1 2295 1852 31 524 95.000000
2 1 38 0 0 0 949 2176 9 205 -1
3 1 38 1 0 0 949 2176 9 205 -1
4 1 38 1 1 0 949 2176 9 205 -1
5 1 38 1 1 1 949 2176 9 205 95.000000
2 1 39 0 0 0 350 2371 1594 11 -1
3 1 39 1 0 0 350 2371 1594 11 -1
4 1 39 1 1 0 350 2371 1594 11 -1
5 1 39 1 1 1 350 2371 1594 11 95.000000
2 1 40 0 0 0 1193 2341 1249 422 -1
3 1 40 1 0 0 1193 2341 1249 422 -1
4 1 40 1 1 0 1910 2341 532 189 -1
5 1 40 1 1 1 1910 2341 532 189 95.000000
4 1 40 1 2 0 1304 2530 1137 99 -1
5 1 40 1 2 1 1304 2530 1137 99 95.000000
4 1 40 1 3 0 1193 2629 1243 134 -1
5 1 40 1 3 1 1193 2629 1243 134 95.000000
5 1 40 1 3 2 1726 2701 710 53 95.000000
2 1 41 0 0 0 1247 2432 369 9 -1
3 1 41 1 0 0 1247 2432 369 9 -1
4 1 41 1 1 0 1247 2432 369 9 -1
5 1 41 1 1 1 1247 2432 369 9 95.000000
2 1 42 0 0 0 1427 2581 408 14 -1
3 1 42 1 0 0 1427 2581 408 14 -1
4 1 42 1 1 0 1427 2581 408 14 -1
5 1 42 1 1 1 1427 2581 408 14 95.000000
2 1 43 0 0 0 1440 2684 286 57 -1
3 1 43 1 0 0 1440 2684 286 57 -1
4 1 43 1 1 0 1440 2684 286 57 -1
5 1 43 1 1 1 1440 2718 153 23 95.783783 MARICOPA
5 1 43 1 1 2 1603 2684 123 55 88.706261 COUNTY
2 1 44 0 0 0 1124 2757 1030 12 -1
3 1 44 1 0 0 1124 2757 1030 12 -1
4 1 44 1 1 0 1124 2757 1030 12 -1
5 1 44 1 1 1 1124 2757 1030 12 95.000000
2 1 45 0 0 0 665 2847 1507 12 -1
3 1 45 1 0 0 665 2847 1507 12 -1
4 1 45 1 1 0 665 2847 1507 12 -1
5 1 45 1 1 1 665 2847 1507 12 95.000000
2 1 46 0 0 0 1242 3100 672 27 -1
3 1 46 1 0 0 1242 3100 672 27 -1
4 1 46 1 1 0 1242 3100 672 27 -1
5 1 46 1 1 1 1242 3101 120 26 94.959305 ANIMAL
5 1 46 1 1 2 1373 3100 141 26 96.337578 MEDICAL
5 1 46 1 1 3 1525 3100 131 26 96.632896 CENTER
5 1 46 1 1 4 1665 3100 109 25 95.204468 VICTIM
5 1 46 1 1 5 1787 3100 29 24 96.472816 ID
5 1 46 1 1 6 1826 3100 88 24 96.753670 22590
Summary of Unclaimed Funds
Warrant Number arrant Date Vendor Name Warrant Amount
11/08/2017 ANIMALMEDICALCENTER == $864.76