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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: March 23, 2018 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — Replacement of Lost Warrant BURGUAN STRICKMAN LAW PLLC/BRIAN STRICKMAN 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 "if );-.3)""+ontil iiiirrivII tor- I 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 moo 2 of this form. BURGUAN STRICKMAN LAW PLLC/BRIAN STRICKMAN (1) being first sworn, upon oath deposes and says: Name/Claimant On or about 20-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 paymeit„ 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 $7,400.00 -(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. (5) Subscribed and sworn to before me this al5r day of AThath__ 20 1g . JESSICA J. BURGUAN Notary Public, State of Arizona My commission expires: My Commission Maricopa County Expires October31, 2021 (seal) Warrant/Check Number 380017519 ink (If known) (6) Original Date of Issue 20-Feb-2018 APR) 1 0 2018 (if known)(7) A Reason for original issue of Warrant/Check (8): - SUPERVISORS r;OUNTY 0 Payroll For Services or Goods furnished Legal Services O Treasurer's refund/payment ▪ Other: