050918 STALE DATED WARRANTS 2.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003 itidetelha
INTEROFFICE MEMORANDUM
Date: April 16, 2018
To: Clerk of the Board
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: LINDA LEE POOLE

\ICA01400623(031 Cco54-
Application for a Duplicate or Stale-Dated Warrant/Check
AffidaviqUaim Form
This application is for: D Duplicate or RI 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
Dade 2 of this form.
Linda Lee Poole (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 21 -Feb -2017 (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 penalp of perjury, claimant hereby affirms that this claim is correct
and the amount show/is due and owing, and tb_e_applicant requests that a replacement
warrant/check beyitsued to himiller in $ 368.00 .(3)
Signed: (4)
Note: Please attacti 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 q-1 1- day of
Ct-T1I11
MARIA K YALE
Notary Public.State of Arizona
My commission expires: Maricopa County
j‘,-, it/ 21k My July Commission 07, 2018 Expires (seal)
Warrant/Check Number 370017010
(if known) (6)
Original Date of Issue 21-Feb-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
m Other: check not cashed V I rn Coinvemacyri
il*, 31o,93