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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 JR PC VC-4733 AD-0005 W#3010000991 $263.79 3/15/18 D750 GAX1D 18-30680 Inv# 418DOYL Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is fan El Duplicate or n Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MAR1COPA numbers on the Instruction sheet which is Daus 2 of this form. CHARLES M WILMER JR PC ON BEI tALF OF TEISHA DOYLE VC ,I733 (• 1) • , being first sworn, upon oath deposes and says: Name/Claimant On or about 15-Mar-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 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 spm of $ 26319 .(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, pre me this 1 -1-"L- 4 day of -pcv , 20 Roxana Rodriguez My commission ex Notary Public c3, Marlcopa County, Arizona (seal) My Comm, Expires 01-31•22 Warrant/Check Number 000003010000991 (if known) (6) Original Date of Issue 15-Mar-2018 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll CI For Services or Goods furnished LI Treasurer's refund/payment Other: Inv# 418DOYL WCMAR2006516756 DOYLE (D750 GAX1D -30680)