112917 DUPLICATE WARRANTS 1.PDF

Maricopa County — Formal (2017-11-29)

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R LJOL
MARICOPA COUNTY O
Department of Finance. r
301 West Jefferson, St6-1660! s5 .3
Phoenix, Arizona 85003 14indtvIdue,‘
INTEROFFICE MEMORANDUM
Date: October 30, 2017
To: Clerk of the Board
From: Walter Chang
Department of Finance
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 1 Affidavits for lost warrants 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 506-8747 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: WALTER INVESTMENT MANAGEMENT CORP
Alias/DBA: DITECH FINANCIAL LLC

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: El Duplicate or El 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
Dade 2 of this form.
Ditech Financial, LLC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 30-Nov-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 que and owing, and the applicant requests that a replacement
warrant/checkly issued t him/her in the sum of $ 2,953 .75 .(3)
Signed: (4)
.7
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 e 20
NOTARY PUBLIC
PATRICIA A. HERPERS
My commission expires: i!‘y Notary Public-Minnesota
_ 19/ My Commission Expires Jan 31, 2020 (seal)
Warrant/Check Number
if known) (6
Original Date of Issue
if known) (7
Reason for original issue of Warrant/Check (8):
RK, BOARD OF SUPERVISORS
1=1 Payroll MARICOPA COUNTY
LI For Services or Goods furnished
1=1 Treasurer's refund/payment
Other: