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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 0.14 0 INTEROFFICE MEMORANDUM Date: January 27, 2017 To: Clerk of the Board From: Beth Brown Department of Finance Subject: Affidavit — Replacement of Lost Warrant Please find attached affidavits for lost warrants to be included on the next available Board Agenda. • The attached items have been researched to ensure the warrants in question haves not been cashed or previously re-issued. • The original warrant have a void/stale date/stop payment done. Please call me at 506-1329 if you have any questions. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960. Thank you. Re: STACY L NYDER ATTORNEY Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 11 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 bade 2 of this form. STACY L HYDER ATTORNEY (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 06 -0ct-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 him/her in,the sum of $ 11,445.00 .(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. (5) Subscribed and sworn to before me this St" day of Notary CYNTHIA Public.State WILLIAMS of Arizona Maricopa County My Commission Expires My commission expires: July 20, 2018 (seal) Warrant/Check Number 370007143 OVED (if known) (6) Original Date of Issue 06-Oct-2016 (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll For Services or Goods furnished during the month of September, 2016 O Treasurer's refund/payment O Other: Wanant Status Change Page 1 of - Warrant 3-7-0007143 Details Wt Number 3-7-0007143 Wt Amount $11,445.00 L Wt Status STOPPED Wt Interest 0 Acct Num 31-768-000 Issue Date 10/6/2016 Paid Date 1/13/2017 Register Date Voucher 000 Claim Number PO Num Fund Number 768 Dept Num 0000 Low Orig 00000 Payee STACY L HYDER ATTORNEY Sub Fund 000 Warrant Status Change The warrant status is currently STOPPED. Please select a new status: 0 Cancel/Void 0 Outstanding Change Status Enter Another Warrant Return to List of Agencies Help for this page ittps://treasurer.maricopa.gov/Agency/FinanceFunctions/statuschange.asp 1/13/201" 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 MARICOPA numbers on the Instruction sheet which is bade 2 of this form. STACY L HYDER ATTORNEY (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 13-0ct-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 him/her in the sum of $483.00 .(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. (5) Subscribed and sworn to before me this ,,Z)/- day ot. 20 /7. DT4 RY PUBLIC CYNTHIA WILLIAMS Notary Public, Slate of Arizona Maricopa County My co mi2on expires: My Commission July 20, 2018 Expires '(seal) Warrant/Check Number 370007658 (if known) (6) R--0--V-E-D- Original Date of Issue 13-Oct-2016 A4 (if known) (7) t.• Reason for original issue of Warrant/Check (8): ERK.BOADur MARICOPA COUNTY 'ERVISORS O Payroll El For Services or Goods furnished September, 2016 O Treasurer's refund/payment O Other: Page 1 of - Warrant 3-7-0007658 Details Wt Number 3-7-0007658 Wt Amount $483.00 Wt Status STOPPED Wt Interest 0 Acct Num 31-768-000 Issue Date 10/13/2016 Paid Date 1/13/2017 Register Date Voucher 000 Claim Number PO Num Fund Number 768 Dept Num 0000 Low Orig 00000 Payee STACY L HYDER ATTORNEY Sub Fund 000 Return to Warrant Lookup Return to Finance Functions Help for this page ittps://treasurer.maricopa.gov/Agency/FinanceFunctions/wtlookup.asp 1/23/201'. Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or 0 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 page 2 of this form. STACY L HYDER ATTORNEY (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 03-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 due and owing, and the applicant requests that a replacement warrant/check be issued to him/her in the sum of $ 15,886.50 .(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 me this ,e5-77--- day 20/ IAMS Notary Public,State of Arizona Maricopa County My Commission Expires My commission expires: July 20, 2018 (seal) Warrant/Check Number 370009113 (if known) (6) Original Date of Issue 12-Oct-2016 (if known) (7) Reason for original issue of Warrant/Check (8): 0 Payroll ( ERK MARICOPA BOARDOFSUPERVISuHl, COUNTY For Services or Goods furnished October, 2016 0 Treasurer's refund/payment El Other: Warrant States Change Page 1 of: Warrant 3-7-0009113 Details Wt Number 3-7-0009113 Wt Amount $15,886.50 Wt Status STOPPED Wt Interest 0 Acct Num 31-768-000 Issue Date 11/3/2016 Paid Date 1/13/2017 Register Date Voucher 000 Claim Number PO Num Fund Number 768 Dept Num 0000 Low Orig 00000 Payee STACY L HYDER ATTORNEY Sub Fund 000 Warrant Status Change The warrant status is currently STOPPED. Please select a new status: 0 Cancel/Void 0 Outstanding Change Status Enter Another Warrant Return to List of Agencies Help for this page Ittps://treasurer.maricopa.gov/Agency/FinanceFunctions/statuschange.asp 1/13/201 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 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. STACY L NYDER ATTORNEY (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 08-Dec-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 him/her in the sum of $ 6,037.50 .(3) Signed: ,41441 (P4 (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 45- 7- day o 20 / 9. Notary CYNTHIA Public,State WILLIAMS of Arizona My Maricopa Commission County Expires My co mission expires: July 20, 2018 2(2 7* Warrant/Check Number 370011784 if known) (6 Original Date of Issue 08-Dec-2016 if known) (7 Reason for original issue of Warrant/Check (8): CLERK, BOARD OF SUPERVISORS MAR'CO'.'A COUNTY 11 Payroll GI For Services or Goods furnished during the month of November, 2016 CI Treasurer's refund/payment 111 Other: Warrant Si.:hange Page 1 of: Warrant 3-7-0011784 Details Wt Number 3-7-0011784 Wt Amount $6,037.50 Wt Status STOPPED Wt Interest 0 Acct Num 31-768-000 Issue Date 12/8/2016 Paid Date 1/13/2017 Register Date Voucher 000 Claim Number PO Num Fund Number 768 Dept Num 0000 Low Orig 00000 Payee STACY L HYDER ATTORNEY Sub Fund 000 Warrant Status Change The warrant status is currently STOPPED. Please select a new status: 0 Cancel/Void 0 Outstanding Change Status Enter Another Warrant Return to List of Agencies Help for this page rt-tps://treasurer.maricopa.gov/Agency/FinanceFunctions/statuschange.asp 1/13/201T