020718 STALE DATED WARRANTS 2.PDF
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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 H13 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: January 16, 2018 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — Replacement of Lost Warrant PARKWAY COMMUNITY CHURCH Please find attached 1 Affidavit for a lost warrant to be included on the next available Board Agenda. • The attached item has been researched to ensure the warrant in question has not been cashed or previously re-issued. • The original warrants have a void/stale date/stop payment done. Please call me at 506-7291 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: IAP2 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 0 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 pane 2 of this form. PARKWAY COMMUNITY CHURCH ( 1), being first sworn, upon oath deposes and says: Name/Claimant On or about 26-Sep-2016 (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 tcAm/her in the sum of $ 75 .00 .(3) Signed: "17 (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. •-•I•••••°, sworn tql5efor e this ID day ofnal &NNIFER MARONI NOTARY PUBLIC - ARIZONA MARICOPA COUNTY My Commission 4(.449 January 24,2 Warrant/Check Number 1370006194 (if known) (6) Original Date of Issue 26-Sep-2016 (if known) (7) Reason for original issue of Warrant/Check (8): D Payroll LII For Services or Goods furnished D Treasurer's refund/payment Other: De lo".) S - 3-0 - I 1.