050918 STALE DATED WARRANTS 3.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003 1426
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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

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 0 Duplicate or [v 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
Daae 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 penalty of perjury, claimant hereby affirms that this claim is correct
and the amount shown is due and owing, and thapplicant requests that a replacement
warrant/check bwissued to himiher in t .(3)
Signed: (4)
Note Please attafin a copy of the warrant/check if available and/or any other
evidgnce that a Arrant/check was originally issued.
(5) Subscribed and worn to before me this day of 2 0 /'.
FtlE1 LIC
Notary MARLA Public,State K YALE of Arizona
My commission expires: M y Commission Maricopa Count Expires y
Litt I • 2e4 July 07, 2018 (seal)
Warrant/Check Number 370017011
(tf knownl (6)
Original Date of Issue 21-Feb-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
111 Payroll
1111 For Services or Goods furnished
El Treasurer's refund/payment
Other: check not cashed \i C (y) Cocpenccilô I\
Nc IC r4t 17 31(plp
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