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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: August 9, 2018 To: Clerk of the Board cz, 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: Fund: 219 / Dept: 190 / MICHAEL F SNYDER : Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or 0 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. Michael Snyder (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 22-Jun-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 himther in the sum of $ 1,990.01 .(3) Signed:7 " (4) Note: Please attach a co& 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 2 day of Q 20 NOTARY PUBLIC :yrAro tV,..,dif,,111 OF ArliZg:k].‘ ikt" JEANNINE mArmo My commission expires: My COR111113SIDIVExplrem Witleiftigf §§; L'Of.10 - (seal) Warrant/Check Number 3010008656 (if known) (6) Original Date of Issue 22-Jun-2018 (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll O For Services or Goods furnished SUPPRVISORS MARICOPA COUNTY E Treasurer's refund/payment Other: Victim Compensation Check CDP‘x,(4-1`) OV-16 \(-646"-Ni4O1 MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM "ID CID Date: August 9, 2018 3310 G7 To: Clerk of the Board t.0 3:1• From: Walter Chang Department of Finance CO 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: Fund: 219 / Dept: 190 / MICHAEL F SNYDER : Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or E] 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 pape 2 of this form. Michael Snyder (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 22-Jun-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 $ 38 . 79 .(3) 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 -Cru_s,LL,0 20 I 1 NOTARY PUBLIC TtrZi., .._=121177==1,0;.11011711011,437IIC NOTAK.f PLI12,0 My commission expires: TL Pi OF -.1 County ARIZa‘lA / JE,V4NINE MARIE ALLEI\i uy CORIIIILISiO K It Expires November oa, 2020 .I•I Warrant/Check Number 3010008657 (if known) (6) Original Date of Issue 22-Jun-2018 (if known) (7) APPROVER' Reason for original issue of Warrant/Check (8): Li i2 ,a-r21 7 O Payroll Cadi-BK BO ABD;i7.)ri 7EPVIS N-7-s! -095 O For Services or Goods furnished MA7,1 COBA • Treasurer's refund/payment Other: Victim Compensation Check -Lc DIck0 kkt-k`-1/4C2.-