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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM CM CI C-1 Date: October 11,2018 To: Clerk of the Board • • From: Walter Chang Department of Finance Subject: Affidavits — Replacement of Lost Warrants Please find attached 1 Affidavits for lost warrants to be included on the next available Board Agenda. • The attached items have been researched to ensure the warrant in question have not been cashed or previously re-issued. • The original warrants have a void/stale date/stop payment done. Please call me at 506-8747 if you have any questions. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960. Thank you. Re: 100 : / Dept : 700 / Facilites / CARUSO TURLEY SCOTT INC o D ( 00 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: v Duplicate or El 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 Dade 2 of this form. CARUSO TURLEY SCOTT INC. (1), being first sworn, upon oath deposes and says: Nanne/Clainnant On or about 03-Jul-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 $ 2,985.00 .(3) (4) Note: Please attach a cdpyyKle warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this g-rt4 day of OCTC)13?"0-. 20 18 . evt0; NOTARY PUBVIC •••II•Iamilboakt"A'AlbmaN dbmaili# MARGIE LUSTER Notary Public - Arizona My commission expires: Maricopa County • • My Comm. Expires May 22, 2022 5• z.2.2022. •••I•••-•••II••••••I•••"'"'"""kseal) Warrant/Check Number 3010009472 (if known) (6) Original Date of Issue 03-Jul-2018 APPROVED (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll ERK, MARICOPA BOARD OF COUNTY SUPERVISORS • For Services or Goods furnished O Treasurer's refund/payment Ci Other: check presumed lost