112917 STALE DATED WARRANT 3.PDF

MARICOPA COUNTY
Department of Finance 2011 I;C• - ;-1L - I n ;• •
301 West Jefferson, Ste 960 VtA"-
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: November 7, 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: SUNOVATIONGMBH CODALE WHIT!

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
page 2 of this form.
Su novation/Heribert Ley (1), being first sworn, upon oath deposes and says:
Nameiciairnant
On or about 03-Aug-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 to Hirpier ip/the sum of $ 150.00 .(3)
Signed: (4)
Note: Please attach a copy of the, warrant/check if available and/or any other
evidence that a warrant/check was 'dginally issued.
(5) Subscribed and sworn to before me this , WI' day of Oc400(.., 20
4ffn ifg 212I14,,, /28"6-fir. 601 CP r5 Obta*b
NOTARY PUBLIC &=ttritrI S 1,11 i4
My commission expires:
lotne_ CC.1‘44/W.L t71.,
Warrant/Check Number 370001892
(if known) (6)
Original Date of Issue 03-Aug-2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
E Payroll
E For Services or Goods furnished
D Treasurer's refund/payment
El Other:
OCT 2 6 2017

File-No. 1703 /2017/H
wiiwi
I hereby certify that the document overleaf was signed in my presence by
Mr Heribert Ley,
Diplom Betriebswirt (FH),
born on 19. September 1961,
living in 51519 Odenthal, Wilhelm-Leuschner-Weg 4,
identified by his official identity card,
acting on behalf of SUNOVATION Produktion GmbH, GlanzstoffstraBe 21, 63820 Elsenfeld
(Germany), as this company's director (Geschaftsfahrer).
Upon my inspection of the commercial register on 11th of October 2017, I further certify that
SUNOVATION Produktion GmbH is registered with the Municipal Court of Aschaffenburg —
Commercial Register — under No. HRB 12571 and that Mr Ley is entitled to act individually as
this company's legal representative.
And I do herby further certify,
that the aforesaid Corporation is duly incorporated;
that it is in good standing under the laws of the Federal Republic of Germany;
that it has a legal corporate domicile is Elsenfeld;
so far as the Commercial Register shows.
Obernburg a. Main, Bavaria, Germany on this 11 th of October 2017
1D8USC