102517 DUPLICATE WARRANTS 2.PDF
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RECEIVED MARICOPA COUNTY SEP 2 0 2017 Department of Finance 301 West Jefferson, Ste 960 MARICOPA BOARD OF COUNTY SUPERVISORS Phoenix, Arizona 85003 CLERK eloo INTEROFFICE MEMORANDUM Date: September 20, 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: Duplicate or El Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MAR1COPA numbers on the Instruction sheet which is paoe 2 of this form. BOBBY AVENT (1), being first sworn, upon oath deposes and says: Name/Glaimant On or about 17-Jul-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 be issued to him/her in the sum of $ 333 . 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 originally issued, oeu rn to before me this 02° day of See 20 1 9— A,14 uu A -..iraw0 •7•Y PUBL C V Tagie "NL Public -Arizona Maricopa County My comnn)s*ion eA2ires: rsIlv • Commission Expires May 7, 20•F: (seal) Warrant/Check Number 380001081 (if known) (6) Original Date of Issue 17-Jul-2017 (if known) (7) DAT SEP/_7201Z Reason for original issue of Warrant/Check (8): Li Payroll ERK, BOARD OF SUPERVISORS MARICOPA COUNTY GI For Services or Goods furnished El Treasurer's refund/payment Other: ' c.