120716 DUPLICATE WARRANTS 1_REDACTED.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: November 10, 2016
To: Clerk of the Board
From: Beth Brown
Department of Finance
Subject: Affidavit — Replacement of Lost Warrant
Please find attached affidavit for lost warrant to be included on the next available Board
Agenda.
• The attached item has been researched to ensure the warrant in question
has not been cashed or previously re-issued.
• The original warrant has a void/stale date/stop payment done.
Please call me at 506-1329 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: JARDINE BAKER HICKMAN & HOUSTON

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
Page 2 of this form.
Jardine Baker Hickman & Houston (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 22-Aug-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/diecl -'---Cipe sued to him/her in the sum of $ 2,674.50 .(3)
Sign (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 / '"( day of ' / 20 /(; .
NOTARY PUBLIC
OFFICIAL SEAL
CHERYL ANN HAYS
My commission expires: Notary Public - Arizona
MARICOPA COUNTY
My Commission Expires (seal)
OCTOBER 21, 2019
Warrant/Check Number 370003535
(if known) (6)
Original Date of Issue 22-Aug-2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
For Services or Goods furnished invoice#249706-07,249710,15,16,18,22,252886
O Treasurer's refund/payment
O Other: APPROVED
DAT", NA1 4 2016
RK, BOARD OF SUPERVISORS
MARICOPA COUNTY

JBHH
Bradley R. Jardine
Stephen C. Baker Jardine Baker Hickman Houston
Scott H. Houston Attorneys
Kendall D. Steele
K. Casey Kurth Phone 602-200-9777
John E. Drazkowski Fax 602-200-9114
Michael Warzynski
Neil C. Alden 3300 N Central Ave Suite 2600
Curtis M. Bergen Phoenix AZ 85012
Stephen M. Venezia
Charles G. Rehling
Terrence Kurth
Gerald T. Hickman (1958-2008)
November 7, 2016
MCAO — Civil
Karrie Bloodhart
222 N. Central Avenue, Suite 1100
Phoenix, Arizona 85004
Ms. Bloodhart:
Please be advised that I, Patricia Adams, am an authorized signer for the law firm,
Jardine Baker Hickman & Houston.
Respectfu
Patricia Adams, CP
PA:ch
Enclosure