082918 DUPLICATE WARRANTS 11.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: August 14, 2018
To: Clerk of the Board
From: Nadine Higuera
Department of Finance
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 2 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 506-1354 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Michael Fifield

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 151 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
page 2 of this form.
MICHAEL FIFIELD (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 03 -Aug -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 $1,430.94 .(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.
worn to before me this / L/' of 6a sr- 20/F.
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R JEFFERS
Notary Public - Arizona
My commissign expires: Commission Maricopa County # 547433
0 5-1/q/1-0 21.2 My Comm. Expires May 19, 2022 (seal)
imipmputipmw
Warrant/Check Number 003010011943
(If known) (6)
Original Date of Issue 03-Aug-2018
(if known) (7)
Reason for original issue of Warrant/Check (8):
ID Payroll
For Services or Goods furnished CLERK, MARImpa BOARD OF miiNTY SUPERVISORS
LI Treasurer's refund/payment
RI Other: warrant wasn't received and presumed lost
Fuwo
(st( Hii\kw\y_miaa

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: f 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
Dacie 2 of this form.
MICHAEL FIFIELD (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 03-Aug-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 $ 204.42 .(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.
orn to before me this Pi* day of ,4-kA (71-20e .
R JEFFERS
5 1 Notary Maricopa Public County - Arizona
My com9lion expires: Commission # 547433
37 if 1-6 My Comm. Expires May 19, 2022 1 eat)
003010011944
Original Date of Issue 03-Aug-2018
(if known) (7)
Reason for original issue of Warrant/Check (8):
0 Payroll
CLERK BOARo c•-=
0 For Services or Goods furnished ••••:4
I=1 Treasurer's refund/payment
Other: warrant was never received and presumed lost
-otQo 645
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