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MARICOPA COUNTY or Department of Finance HARICOT/. 301 West Jefferson, Ste 960 2018 AUG - 8 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: August 8, 2018 To: Clerk of the Board From: Maria Meza Department of Finance Subject: Affidavits — Replacement of Warrant Please find attached Affidavit for reissue of lost warrant to be included on the next available Board Agenda. • The attached items have been researched to ensure the warrant in question has not been cashed or previously reissued. • The original warrant has a void/stale date/stop payment done. Please contact 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: WILSON ELEMENTARY SCHOOL VC-8905 W#3010000255 03/05/18 $5785.24 Inv # CBSI222018-YR2 GAX1D 18-28854 GF-715 D370 Education Services Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 7 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 one 2 of this form. WILSON ELEMENTARY SCHOOL VC-8905 (.i.) being first sworn, upon oath deposes and says: Name/Claimant On or about 05-Mar-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 hirg/her in the sum of $ 5,785.24 .(3) Signed: ,40 /1'/irizefriK2 (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),S4scribed and sw to before me this =day of tt- 204. orlarthrariardb.Yrardilhataresig NOTARY PUBLIC ALICIA GUZMAN Notary Public - Arizona Maricopa County My commis/on *fres: My Comm. Expires Dec 19, 2021 /2/19/2/ 01I••••I•I•••I•I•III•16~4•PIP% (seal) Warrant/Check Number 3010000255 if known) (6 05-Mar-2018 iro 11VMM Reason for original issue of Warrant/Check (8): 41Ir "I4V/ LA CLERK, BOARD OF SUPERVISORS D Payroll MAFilCOPA CO UNTY CI For Services or Goods furnished 111 Treasurer's refund/payment U Other: Inv#CBSI222018-YR2 Compounding Base Salary Inc. Yr 2 Dec/Jan Fund 715 D370 Education Services