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Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: V. Duplicate or D 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. Lewis Roca Rothgerber (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 10-0ct-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 sh wn is due and owing, and the applicant requests that a replacement warrant/check I;Ls5 uqd/ibe4 the sum 32,305.90 .(3) Signed: jx, (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 1±4 to before me this // day of A/oVErive._ 20_4L. / , NOTARY' PUBLIC MARIE H. MANCINO Notary Public- State of Arizona My commission expires MAR ICOPA COUNTY 5.=,) My Commission Expires Feb. 25,2018 (seal) Warrant/Check Number 370007340 APPROVED (if known) (6) Original Date of Issue 10-Oct-2016 (if known) (7) Reason for original issue of Warrant/Check (8): CLERK. MARICOPA BOARD OF COUNTY SUPERVISORS El Payroll For Services or Goods furnished invoice#1169642 & #1173763 111 Treasurer's refund/payment CI Other: Lewis Roca ROTHGERBER CHRISTIE Ker ,leth Van 1".iln 1ve Jr, Lewis Roca Rothgerber Christie LLP A.dinlited Ari.„(,; la 201 East Washington Street 602 262 5311 main 602.262.5357 direct Suite 1200 602 262 5747 fax 602.734.3763 fax Phoenix, AZ 85004 Irrc.com kvanwinkle@Irrc.corn November 4, 2016 MCAO - Civil Attn: Karrie Bloodhart 222 North Central Avenue, Suire 1100 Phoenix, Arizona 85004 Re. Application for a Duplicate or Stale-Dated Warrant/Check Ladies and Gentlemen: This letter is to inform you that Kevin Posterro, Chief Financial Officer, is an authorized signer for Lewis Roca Rothgerber Christie LLP. Very truly rs, nneth Van Winkle, Jr. Managing Partner Lewis Roca Rothgerber Christie LLP KVW:dls 2011486333_1 Albuquerque / Colorado Springs / Denver / Irvine / Las Vegas / Los Angeles / Phoenix / Reno / Silicon Valley / Tucson )isbursement Query Page 1 of Disbursement Query Menu Back Search Check Issued Disbursement Document Vendor Code Vendor Name Payee Name Amount Date ';., AD,D180,WAR000007409,1 VC0000006836 LEWIS ROCA ROTHGERBER LLP LEWIS ROCA ROTHGERBER LLP $32,305.90 10/10/2016 00 First Prey Next Last Record Date : 107 0/2016 Total Discount Amount : $0 00 Disbursement Doc Type : AD Total Penalty Amount : $0.00 Disbursement Doc Code : Total Interest Amount : Disbursement Doc Dept : b180 Total Backup Withholding Amount : $0.00 Disbursement Doc ID : WAR000007409 Total Contract Withholding Amount : $0.00 Payee Code : Total default Intercept Fee Amount : Payee Name : LEWIS ROCA ROTHGEF Total Supplementary Intercept Fee Amount : Payee Indicator : v Total Retainage Amount : $0.00 Total Accounting Line Amount : $32,305.90 Total Freight Amount : $0.00 Total Intercept Amount : $0,00 Total Use Amount : $0.00 Issued Date : 10/10/2016 Total Tax Amount : $0 00 Check/EFT Number : 000000370007340 Cancel/Reclass Reason : I Check Status : Disbursed Vendor Code : VC0000006836 Cleared Date : Vendor Name : LEWIS ROCA ROTHGEf Check Amount : .$32,305 .90 Disbursement Category : Top Disbursement Detail Query Intercept Activity Retainaqe Detail Accrual Inquiry ittps://azdom.hostams.corn:1443/webapp/PRDFIN1X1/Advantagejsessionid=00009_G14unTMK8I0_-pR... 11/8/201(