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mu VOir, 9k VW' MARICOPA COUNTY Department of Finance I 'I' 301 West Jefferson, Ste 960 2013 23 N112: 37 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM MEMORANDUM Date: January 23, 2018 To: Clerk of the Board From: Nadine Higuera Department of Finance Subject: Affidavits — Replacement of Lost Warrants Please find attached 1 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 warrants have a void/stale date/stop payment done. Please call me at 506-1354 if you have any questions. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960. Thank you. Re: RHONDA KAY BEAL 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 Dam 2 of this form. RHONDA KAY BEAL (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 21-Apr-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/che b issued to him/herjathe sum of $ 170.00 .(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. ubscribed and swo 7r5i to before . I me this 10 day of 20_11. 2c7_ct_4r%.-Q---) NOTARYPUBLIC 1 ... ., REGINA L HORNER l__ commission expires: MY COMMISSION #FF147489 D (6 g 1f4;;vier EXPIRES August 3, 2018 (seal) (4w) iiii.oiD3 F)oridallotarySBMCe.COm Warrant/Check nnown) Number 374909940- 3Oo oL (6) Original Date of Issue 21-Apr-2017 I/ ED _ (If known) (7) JA 27-1018 Reason for original issue of Warrant/Check (8): DAT 0 Payroll , BOARD DP- SuPERVISORS MARICOPA COUNTY 0 For Services or Goods furnished 0 Treasurer's refund/payment Other: LOST-NEVER RECEIVED -?(3 Ca2Lz çQ Sq5i 6R4s-rni a-LA/01/44 gem..Tbr.)i 25SS —DVA610r11-t.3 1-6 ti31)At-,4 P11331S, Ce-Rfc-A0