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MP \-V°00,Ny MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: April 3, 2018 To: Clerk of the Board From: Maria Meza Department of Finance Subject: Affidavit — Replacement of Lost Warrant.. Please find attached Affidavit for lost warrant 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 warrant have a void/stale date/stop payment done. Please call me at 506-1336 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: PETER JOSEPH SLTNENSHINE VC-10360 W#380001448 $1050.00 7/20/17 D750 GAX1D 17-50931 Inv# 713DREY Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 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 page 2 of this form. PETER JOSEPH SUNENSHINE VC-10360 0.) ‘. being first sworn, upon oath deposes and says: Name/Claimant On or about 20-JuI-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 beii d to him/her in the sum of $ 1 ,050.00 .(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 iAc, day of McuA, 20 1 NOTARY PUBLIC UNDALEE CHOUKALAS Notary Pita - Stets c4 Arizona MARICOPA COUNTY My crlission expires: ComMise Apra 6, lo 2021 n Expires 4 (4 ,Abat (seal) Warrant/Check Number 000000380001448 (if known) (6) Original Date of Issue 20-Jul-2017 AP hl 0 21110 (if known) (7) Reason for original issue of Warrant/Check (8): MARIGOPA _ COuNTv _RV1SORS Payroll For Services or Goods furnished Inv# 713DREY Warrant not received by vendor/Lost in mail El Treasurer's refund/payment El Other: