STAMPED & REDACTED - FOR AGENDA ATTACHMENT - ADA HOOD.PDF

AR COPA
COUNTY
Office of Budget & Finance To: Clerk of the Board
_
301 W. Jefferson St, 9" Floor From: Office of Budget & Finance, Accounts Payable
. Phoenix, Arizona 85003
Date: 01.12.24
Subject: Affidavit — Ada Hood
P: 602-506-3561
F: 602-506-4451
Please find attached one Affidavit for a duplicate warrant to be included on the next
Maricopa.gov available Board Agenda.
« The attached item has been researched to ensure the warrant in question has not
been cashed or previously reissued.
e The original warrant is presumed lost.
Please call Marcia Bulanda at 506-7291 if you have any questions. Please return the
approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor.
Thank you.
Re: D240 Justice Courts—Fund 100-—GAX1D 24*10068- Refund-White Tank Justice Court

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/ Claim Form
This application is for: iy] Duplicate or [| Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA sees oheon sheet which is
ADA HOOD (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 97-Dec-2023 (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 js
na 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/¢ be issued to him/her in the sum of $ 179.99 (3)
iat
elk LA Le \ (4)
Signed: £0
‘Please he
Note: aitach a copy of warrant/check if available and/or any other
evidence that a warrant/check was originally issued,
Subscribed and sworn me this day of_ Adveveyse20_2?.
0)
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“KIOTARY PUBLIC
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GEORGE P MCKINLEY
| _ Notar Puli : Ar
ig fz: fy Q ? Commission # 858276 (seal)
= _E_ MY Commission Expires December 19, sno
Ww akan t/Check Numb 3010168022
briny ideal
Original Date of Issue 07-Dec-2023
GE known) (7)
Reason for original issue of Warrant/Check (8):
(} Payroll
C For Services or Goods furnished
C1 Treasurer’s refund/payment
Court ordered refund of fines and fees paid online
Other:
1/17/2024

BOUNTY EXPENSE WARRAKT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010168022
DATE
12-07-2023
91-2/4221
One Hundred Seventy Nine And 99{100 Dollars
$179.99
PAY TO THE ORDER OF
AMOUNT
Ada Hood
Void After
365 Days
For Questions - 602-506-1379 or email AP@MATL.MARICOPA GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
_
MREFUND 3010168022 L2/7/2023 $179.99
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
C7T2023215636 Refund-White Tank Justice Court GAX1D D240 240000010068 179.99
240000010068

C] Agency Status Warrant number — Issued date Paid date Amount
~ issued 3O10TReD22 we ¥ ” ‘.
2000 Issued aD104 BB022 TPF 2023 12:00:00 arm 175.99 |
Warrant number 201G1H2022
Amount Payee Acegunt