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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: April 9, 2018 To: Clerk of the Board From: Maria Meza Department of Finance Subject: Affidavits — 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 return the approved Affidavit to my attention in the Department of Finance, Suite 960. Please call me at 506-1336 if you have any questions. Thank you. Re: CHARLES M WILMER TR PC VC-4733 AD-0004 W#3010000990 $472.55 03/15/18 D750 GAX1D 18-30681 Inv# 418W00D Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for; 0 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. CHARLES ta WILMER JR PC ON BEI IALF OF JEAN WOODRING VC4733 (I) • being first sworn, upon oath deposes and says: Name/Claimant On or about 5-Mar-201 8 (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 4suec1 to him/her in the sum of $ 472-55 - (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 e me this H114' day of 2O( . NOTARY PUBLIC xana Rodriguez My commission expires: tary Public County, Arizona (seal) am DPhil 01.31.2g Warrant/Check Number 3010000990 (if known) (6) Original Date of Issue 15-Mar-2018 (if known) (7) Reason for original issue of Warrant/Check (8): K. BOARD OF SIJ I-1 ERVISORS 0 Payroll MARICODA CO 0 For Services or Goods furnished LI Treasurer's refund/payment El Other: Inv# 418WOOD WCMAR2004435243 WOODRING (D750 GAX1D-30681)