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4505 E Chandler Blvd, Ste. 110 SECURITY _Ta.L7 [r Phoenix, AZ 85048 Phone: (480) 706-4154 TITLE AGENCY Fax: (480) 706-6696 September 7, 2018 Board of Supervisors 301 W. Jefferson St. 10 th Floor Phoenix, AZ 85003-3561 Re: Parcel No. 163-08-089 To Whom It May Concern: Please re-issue the attached check. It was lost and located when going through old paperwork. It is now stale dated. Thanks for your help!! I hu Kim F, lix Assistant Vice-President/Branch Manager Security Title Agency 4505 E. Chandler Blvd. Ste. 110 Phoenix, AZ 85048 Office: (480) 706-4154 Direct Office: (480) 874-7402 Fax: (480) 706-6696 kfelix@securitytitle.com RECEIVED SEP 12 2018 MARICOPA COUNT' CLERK BOA.117. 01 2 6,IPERVISORS Ltrhead Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 0 Duplicate or 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. SECURITY TITLE AGENCY (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 19-Sep-2016 (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 $407.72 .(3 ) 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) S i • - 11 rn to before me this day of Odoipe,7 20 A offit ,„ NOTA,r •A PUBLIC I w• JULIE T. ESPISITO Notary Public- State of Arizona PIMA COUNTY My cqmmission expires: My Commission August 8, 2020 Expires (seal) Warrant/Check Number 846241 (if known) (6) Original Date of Issue 19-Sep-2016 (if known) (7) Reason for original issue of Warrant/Check (8): LI Payroll El For Services or Goods furnished Treasurer's refund/payment REFUND SLIP ID: 201600654 0 Other: