022118 DUPLICATE WARRANTS 10.PDF

MARICOPA COUNTY :.),\Ri) OF SUPPJ;
Department of Finance
301 West Jefferson, Ste 960 2013 FEB -5 El 1: 57
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: February 5, 2018
To: Clerk of the Board
From: Maria Meza
Department of Finance
Subject: Affidavit — 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 warrants have a void/stale date/stop payment done.
Please call me at 506-1336 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: Encanto JP V# ENCANT JP
W#380008637 10/25/17
$425.00

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1 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
page 2 of this form.
Encanto JP (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 25-Oct-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/check laie issued to him/h,er in the su of $425.00 .(3)
Signed: _wetlif(tit__, (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 to before me this day of 20 1 W.
NOTARY PUBLIC
BECKY VALDEZ
Notary Public - Slate of Arizona
My commission expires: MARICOPA COUNTY
My Commission Expires
un-e June 23, 2018 (seal)
Warrant/Check Number 380008637
(if known) (6)
Original Date of Issue 25-Oct-2017
(if known) (7)
Reason for original issue of Warrant/Check (8):
APPROVED
0 Payroll FEB 2
IDAT
0 For Services or Goods furnished _
LI Treasurer's refund/payment CLERK, mA,---CCHA BOAR:DO ,' 77'
Other: Jail Bonds