030817 DUPLICATE WARRANTS 1_REDACTED.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
LI
Date: February 6, 2017
c .
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: IAP2

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1 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
Parte 2 of this form.
117 (1), being first sworn, upon oath deposes and says:
Nameiciatrnont
On or about 20-Oct-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 daim 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 $ 420.00 .(3)
Signed: IT .(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 me this 2,U2 day of 20.11 .
ABRIL MONTSERRAT HERNANDEZ-LOPEZ
My commission expires: STATE NOTARY OF COLORADO PUBLIC
to/04 2-0 1-'21 NOTARY ID 20154037485 (seal)
MY COMMISSION EXPIRES OCTOBER 2, 2019
Warrant/Check Number 00370008246
If known) (6
Original Date of Issue 20-Oct-2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
D Payroll
LI For Services or Goods furnished
0 Treasurer's refund/payment
Other: warrant lost in mail I never received/ membership fees

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
It=
Date: February 6, 2017 ••••I -;.•
-Ti
To: Clerk of the Board 1
0-1
From: Walter Chang
Department of Finance
Subject: Affidavits — Replacement of Lost Warrants f's.)
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: IAP2

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1 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.
IAP2 (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 26-Oct-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 daim 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 $ 140.00 .(3)
Signed: 11101 (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 me this 2 Litt' day of jr6LIA 20 17 .
1 I—eA,=-Le-rtekeet____
NOTARY PUBLIC
ABRIL MONTSERRAT HERNANDEZ-LOPEZ
My commission expires: STATE NOTARY OF COLORADO PUBLIC
70/07-i2-0/ NOTARY ID 20154037485 (seal)
I I v (10A1MISSION EXPIRES OCTOBER 2,2019
Warrant/Check Number 003370008570
(If known) (6)
Original Date of Issue 26-Oct-2016
(if known) (7) A P P .
Reason for original issue of Warrant/Check (8): DAT A FEB
LI Payroll AK, \, bERVSORS
For Services or Goods furnished MARICOPA COUNTY
0 Treasurer's refund/payment
Other: warrant lost in mail / never received/ membership fees