Extracted text (via pymupdf_layout)
2484 characters
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 WILMFR JR PC VC-4733 PA001 W#3010000992 $446 , 3/15/18 D750 GAX1D 18-30679 Inv# 41 8VANC Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or D 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 Page 2 of this form. CHARLES M WILMER JR PC VC-4733 (1), being first sworn, upon oath deposes and says: Name/Clalmant 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 issyed to him/her in the sum of of $446.00 .(3 ) Signed: 14/z/ (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a wan-ant/check was originally issued. (5) SullecLarKI sworn to before me this 1-141k) day of -tkc 20\ . NOTARY PUBLIC Roxana Rodriguez Notary Public My commission expires: Maricopa County, Arizona My Comm. Expires 01-31-22 (seal) ••I•I• Warrant/Check Number 3010000992 (if known) (6) Original Date of Issue 15-Mar-2018 flf known) (7) Reason for original issue of Warrant/Check (8): LERK, BOARD OF SUPERVISORS Li Payroll MARICOPA COuvrv 0 For Services or Goods furnished El Treasurer's refund/payment Other: Inv# 418VANC WCMAR2007537510 VANCE (D750 GAX1D-30679)