091918 DUPLICATE WARRANTS 3.PDF

MARICOPA COUNTY SOAPD OF CLEr1", SUPER JI'S
Department of Finance MARICOP4
301 West Jefferson, Ste 960 UM AUG 21 Atl 10: 59
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: August 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: MVICTIM LORENA MONSIVAIS
W#3010008652 $598.69
D190 GAX1D 18-44395
Inv #00000056745C
Fund-219 Dept-D190 County Attorney

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: TE 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
Pacie 2 of this form.
CCe v'I 1,r (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about _ (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 $ Sel CK .(3)
Signed: 101'010 J1onUa 5 (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 q,&c..tL.,k 20 g .
NOTARY PUBLIC
VERONICA RAZO
My commission expires: NoblriPubk-StateolArtzone 11.4ARICOPA COUNTY
r j aoly My Novanter CoMMNSIOn 6, 2018 Expires (seal)
Warrant/Check Number
(if known) (6)
Original Date of Issue
(if known) (7) - - I
[ APPROVED
Reason for original issue of Warrant/Check (8): _
LI Payroll
._.1ERVISORS
0 For Services or Goods furnished \
0 Treasurer's refund/payment
Other: C- ee c_ cp t
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