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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: October 17, 2017 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — Replacement of Lost Warrant Please find attached 1 Affidavit for a 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 506-7291 if you have any questions. Please return the approved Affidavits 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: EJ 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 page 2 of this form. amAO D • aUFF (1), being first sworn, upon oath deposes and says: P e/Claimant On or about 9 -15- 17 (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 him/hr ig,She sum of $ £70 .(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. (5) Subscribed and sworn to before meitOis day of OCA-dagr 20 . k NOTARY PUBLI My commission expires: =W: - (seal) • 4/.`.'00, 27 Warrant/Check Number 39.cxx) ss 11101111150V r"P‘ (if known) (6) Original Date of Issue (if known) (7) q,(1412.o t -7 Reason for original issue of Warrant/Check (8): 111 Payroll APPROVED El For Services or Goods furnished DT T2 0 2017 CD 11/Treasurer's refund/payment .41110 . - C==3 VP" Or SUPhriViSOHS El Other: MARICOPA COUNTY c=> MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: October 17, 2017 To: Clerk of the Board From: Marcia J. Clark Department of Finance Subject: Affidavit — Replacement of Lost Warrant Please find attached 1 Affidavit for a 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 506-7291 if you have any questions. Please return the approved Affidavits 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 IN Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF PIARICOPA numbers on the Instruction sheet which is pade 2 of this form. VANGUARD TRUCK CENTER OF PHOENIX (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 13-Sep-2017 (date)(2) a warrant/check was issued to the above named person/entity in the amount as stated below. Such warrnt/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 warrantithaQk be issued l to him/iIhJm of $ 300,010.00 -(3) Signed)=='%'•/% (4) Note; Please ach 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 I - day of 0 'do bet- 20 rt NOTARY PUBLI ALEXANDER SANCHEZ My commission expires: Notary Public • Slate of Arizona 6 /a s-faGal My MAR Commission ICOPA COUNTY Expires (seal) June 28, 2021 Warrant/Check Number 380005491 (if known) (6) APP chi VED Original Date of Issue 13-Sep-2017 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll MARICOPA COUNTY For Services or Goods furnished El Treasurer's refund/payment 0 Other: k.S3 CI)