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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 w6-0 6' 6\0. INTEROFFICE MEMORANDUM Date: March 20, 2018 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — Replacement of Lost Warrant CITY OF CHANDLER WATER DEPARTMENT 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. Re: IAP2 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: ID Duplicate or El 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 nape 2 of this form. City of Chandler Water Department (1), being 'first sworn, upon oath deposes and says: Name/Claimant On or about 28 -Aug -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 the applicant requests that a replacement warrant/check be issued to him her in the sum of $ 520_00 .(3) Signed: S r (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. ribed and worn to 54d M _ N. IAA_ AN OFFICIAL SEAL HOLLY M. GRANILLO My, commission expires: NOTARY MARICOPA PUBLIC • COUNTY State of Adzona cliwiZoict My Comm. Expires SepternixAg1)9 Warrant/Check Number 380004384 (if known) (6) Original Date of Issue 28-Aug-2017 (if known) (7) APPROVE -II Reason for original issue of Warrant/Check (8): [A Payroll For Services or Goods furnished LI Treasurer's refund/payment a Other: warrant never received