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co • - Y.Vcs'Alk m tk CLERK MARICOPA COUNTY !WARD OF SUPERVISOR'S MARICOP COUNI Y Department of Finance 301 West Jefferson, Ste 960 2016 MAY I AM 9: 0 I Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM MEMORANDUM Date: May 1,2018 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — Replacement of Lost Warrant ED SPELDY EAST COMPANY LTD Please find attached 1 Affidavit for a lost warrant to be included on the next available Board Agenda. • The attached item has been researched to ensure the warrant in question has not been cashed or previously re-issued. • The original warrants have a void/stale date/stop payment done. Please call me at 506-7291 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 1 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 Palle 2 of this form. ED SPELDY EAST COMPANY LTD. (1), being first sworn, upon oath deposes and says: tiairne7Gialmant On or about 21-Feb-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, pr 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 $ 619.00 .(3) Signed: - ./-i 2-2 -----7(-- (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) Subspiped and sworn to before me this 0/`') day of I I 20 MARTIN SHEPPARD FRASER LLP. id 1-A- NEIL A. VIOLA NOTARY PUBLIC Barrister & Solicitor 437 Mississauga St., Box 900 My commission expiresi: Niagara-on -the -Lake, ON n exedd od 0104K, LOS 1J0 (seal) Warrant/Check Number 380017617 (if known) (6) Original Date of Issue 21-Feb-2018 (If known) (7) Reason for original issue of Warrant/Check (8): _ CLERK. BOARD OF SUPERN'._ , L,, D Payroll MARICOPA COUNTY LI For Services or Goods furnished D Treasurer's refund/payment Other: Warrant Lost in the Mail