041118 STALE DATED WARRANTS 2.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960 21110 -,(3 r • ,,,;(1
Phoenix, Arizona 85003 6.nn P" 46)0 41, 441(f" ' 00 or\
INTEROFFICE MEMORANDUM
Date: March 8, 2018
To: Clerk of the Board
From: Beth Brown
Department of Finance
Subject: Affidavit — Replacement of Stale Dated Warrants
Please find attached affidavit for stale dated warrants to be included on the next
available Board Agenda.
• The warrants requested to be reissued are also attached. The warrants in
question have not been previously re-issued.
• The original warrant has a void/stale date/stop payment done.
Please call me at 506-1329 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: KAMMER ENTERPRISES
DAVID M KAMMER

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El Duplicate or 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
oacie 2 of this form.
ck; ,), C 11_ (1), being first sworn, upon oath deposes and says:
Name/Ciaimant
On or about See attachment (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/ch issued to him/her in the sum of $ See attachment .(3)
Signed: L4
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 day of 20
NOTARY PUBLIC S. ee
akV'\
My commission expires:
(seal)
Warrant/Check Number
(if known) (6)
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8):
CD Payroll
,D For Services or Goods furnished
O Treasurer's refund/payment
O Other:

A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Sot. Utics Ilia,
Subscribed and sworn to (or affirmed) before me on this i6 1-4'
day of C--elof\A0 7 , 20 I , by VA M ic-tolotefe-
proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
ROBERT JAMES GRIFFITH
COMM.# 2176319 Li
NOTARY PUBLIC - CALIFORNIA O.
SA1 C3 .: I LUIS -f1;1. Fh.;-Iires OBISPO Dec. COUNTY 1,9.,;42.0200.1
1nature 721—V

Summary of Unclaimed Funds
Warrant Warrant # Amount Vendor Name
Date
8/5/2015 360003120 $25.00 Kammer Enterprises
12/7/2015 360013168 $25.00 Kammer Enterprises
1/6/2016 360015395 $25.00 Kammer Enterprises
2/9/2016 360018148 $25.00 Kammer Enterprises
4/11/2016 360023265 $25.00 Kammer Enterprises
5/4/2016 360025442 $50.00 Kammer Enterprises
6/7/2016 360028345 $50.00 Kammer Enterprises
8/3/2016 370001861 $100.00 Kammer Enterprises
9/2/2016 370004206 $200.00 K3rlirrter Enterprises
10/13/2016 370007612 $200.00 Kammer Enterprises
11/8/2016 370009273 $100.00 Kammer Enterprises
1/10/2017 370014187 $100.00 Kammer Enterprises
Total $925.00