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MARICOPA COUNTY 3 OAR D OF Slif-'17 Department of Finance HARICOPA C01_1;11 Y 301 West Jefferson, Ste 960 2818 Phoenix, Arizona 85003 SEP 21 Pt! 1: 25 0 4.0101 0#6„ INTEROFFICE MEMORANDUM Date: September 21, 2018 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: VC-4919 COURTYARD BY MARRIOTT W#3010008074 $409.33 D800 IN 18-70733 $303.29 & IN 18-70735 $106.04 Inv #311K500009667 & 311K500009636 Fund-100 Dept-D800 Superior Court Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or ri 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 Dace 2 of this form. VC-4919 Courtyard by Marriott (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 14-dun-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 bA issued to himftler in the sum of $409-33 .(3) Signed: (4) Note: PleaS-e attach a copy of the warrant/check if available and/or any other evidence that a warrant/check- was originally issued. e (5) Subscribed and sworn to before me this /(0 day of-La:141k 20 NANCY J. KALE NOTARY PUBLIC - ARIZONA Maricopa County My Commission Expires seal) March 27, 2019 Warrant/Check Number 3010008074 (if known) (6) APIROV AA Original Date of Issue 14-Jun-2018 (if known) (7) Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISORS NA=\ RICO PA COUNTY O Payroll D For Services or Goods furnished Inv# 311K500009667 & 311K500009636 0 Treasurer's refund/payment D Other: Fund-100 Dept-D800 Superior Court IN 18-70733 $303.29 IN 18-70735 $106.04