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MARICOPA COUNTY MARICOPA OF SIJP1-:- CCHT Department of Finance 301 West Jefferson, Ste 960 2818 SEP 26 AM II: 40 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: September 26, 2018 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — Replacement of Lost Warrant MICHAEL D. STRAUBER ATTORNEY Please find attached 1 Affidavit for a 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 warrants have a void/stale date/stop payment done. Please call me at 506-7291 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. FUND 100- D560 PUBLIC DEFENSE SERVICES (CONTRACT COUNSEL) Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 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 cage 2 of this form. MICHAEL D. STRAUBER ATTORNEY /1) , being first sworn, upon oath deposes and says: Name/Claimant On or about 17-Jan-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 $ 330.00 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) Subscribed and sworn to before me this day of `\,- .voiscrm,,, nt- ,I,, 20 I . ÷,7_74614.46,./ 0‘ oP, eta° ...... p 4L o '. NOTARY PUBLIC 1+° S — _ My commission expires: =11 '• 47 ,!-‹ :: S °C;•*; '•47 4 1 ° SI A .0- - *al) Warrant/Check Number 380014895 :0V (if known) (6 411/UMW Original Date of Issue 17-Jan-2018 if known) (7 TIO Reason for original issue of Warrant/Check (8): O Payroll For Services or Goods furnished PROBATE REP CLERK, MARICs:vs BOARD = O Treasurer's refund/payment O Other: P (-) 1° ; bekenSe- 5eJZAVe.s r WO 1 0 b56b (con4-f-Ack OA SL)