110216 DUPLICATE WARRANTS 10.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: October 27, 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: BARNES & NOBLE
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Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: -Duplicate or ID Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICO numbers on the Instruction sheet which is
gage 2 of this form.
), being first sworn, upon oath deposes and says:
(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 ryuests that a replacement
warrant/iètk be issued to him/her ' the of $ ' -(3)
t
Signa, -,1-4-)1C—* ) (4)
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
js ih
(5) ubscribed and sworn to before me this day of 2O/.
xdia- 7/tau) a
NOTARY PUBLIC
Sandra Lee Crawford
My commission expires: Notary Public of New Jersey
(seal) j
Commis ion Expires 20 t)
Warrant/Check Number 3(900,_ 16 3 3
(if known) (6)
Original Date of Issue
(if known) (7)
Reason for original issue of Warrant/Check (8):
0 Payroll
OT For Services or Goods furnished n0
a Treasurer's refund/payment
El Other:
AtiPitOVED
OAT 001,2 6 2;16
AK, BOARD OF SUPER VISORS
MARICORA COUNTY

BARNES NOBLE
Maricopa Co Sheriff's Office
550 West Jackson St.
Phoenix, AZ 85003
October 20, 2016
Subject: Affidavit
Gentlemen:
Susan Williams, our Accounts Receivable Representative, is authorized to sign for Barnes & Noble.
Thank you.
Joseph Mascia
Barnes & Noble
Accounts Receivable Manager
12660 Old Virginia Road, Reno, NV 89521 te/: (775) 327-6500

Page 1 of 1
Transaction 322$033
Bill To: Ship To: Invoice Number
MARICOPA CO SHERIFFS 3228033
OFFICE Billing Date Shipping Date
ACCT PAY FINANCIAL SERV 03/30/2016
DIV Purchase Order Number
550 WEST JACKSON ST, PD16500050094
4TH FLOOR Sales Order
PHOENIX, AZ 85003
Shipping Reference Ship Via
Remit To:
Barnes & Noble, Inc. Customer Number Customer Location
PO Box 930455 6896872 179943
ATLANTA, GA 31193-0455
Terms Due Date Store Number Authorized Purchaser
30 NET 04/29/2016 2560 ANDREA GIACOMUZ
Previous 1-25 I Next 25
Item Num Description Quantity Shipped Unit Price Extended Amount
1 FIRST PART LAST 3 (6.39) (19.17)
2 POSITIVE: A MEMOIR 1 (15,19) (15.19)
3 CONCUSSION / (B&N WS UVDC AC3) 1 18.89 18.89
4 MARTIAN 1 20.99 20.99
5 RISE OF THE ELGEN (MICHAEL VEY 1 8.79 8.79
6 PRISONER OF CELL 25 (MICHAEL V 1 8.79 8.79
7 BATTLE OF THE AMPERE (MICHAEL 1 8.79 8.79
8 HUNT FOR JADE DRAGON (MICHAEL 1 9.59 9.59
9 IRON WARRIOR (IRON FEY SERIES 1 7.99 7.99
10 IN REAL LIFE: MY JOURNEY TO A 1 12.80 12.80
11 IN REAL LIFE: MY JOURNEY TO A 1 12.80 12.80
12 IN REAL LIFE: MY JOURNEY TO A 1 12.80 12.80
13 TWELVE CAESARS: THE DRAMATIC L 1 14.39 14.39
14 CHARLIE WILSON'S WAR: THE EXTR 1 11.96 11.96
15 GATEWAY TO FREEDOM: THE HIDDEN 1 13.56 13.56
16 WHEN THE GAME WAS OURS 1 12.76 12.76
17 LIFE AS WE KNEW IT COLLECTION 1 23.99 23.99
18 FOUR: A DIVERGENT COLLECTION 1 10.39 10.39
19 WOODLAWN: ONE HOPE. ONE DREAM, 1 12.80 12.80
20 WOODLAWN: ONE HOPE. ONE DREAM. 1 12.80 12.80
21 FOUR: A DIVERGENT COLLECTION 1 10.39 10.39
22 ISAAC'S STORM: A MAN, A TIME, 1 12.76 12.76
23 IRON WARRIOR (IRON FEY SERIES 1 7.99 7.99
24 IRON WARRIOR (IRON FEY SERIES 1 7.99 7,99
25 VINDICO 1 7,19 7.19
'revious 1-25 ••• Next 25
SubTotal 281.20
Special Instructions Tax 24.19
Note: Discounts reflected in unit pricing above. Shipping 0.00
Total 305.39
Payments and Credits 0.00
Financial Charges 0.00
Outstanding balance as 305.39
of 10/03/2016 in USD
https://finapprd.hq.bn-corp.com:9443/0A_HTMURFjsp?functionid=14697&respid=50413&resp_appl_id=222&security... 10/3/2016

Transaction 3228033 Page 1 of 1
Bill To: Ship To: Invoice Number
MARICOPA CO SHERIFFS 3228033
OFFICE Billing Date Shipping Date
ACCT PAY FINANCIAL 03/30/2016
SERV DIV Purchase Order Number
550 WEST JACKSON ST, PD16500050094
4TH FLOOR Sales Order
PHOENIX, AZ 85003
Remit To: Shipping Reference Ship Via
Barnes & Noble, Inc. Customer Number Customer Location
PO Box 930455 6896872 179943
ATLANTA, GA 31193-0455
Terms Due Date Store Number Authorized Purchaser
30 NET 04/29/2016 2560 ANDREA GIACOMUZ
Previous 25 26-29 of 29 'v Next
Item Num Description Quantity Shipped Unit Price Extended Amount
26 INSURGENT (DIVERGENT SERIES #2 1 10.39 10.39
27 FEROS 1 7.99 7.99
28 ONE SECOND AFTER 1 7,99 7,99
29 ONE SECOND AFTER 1 7.99 7.99
Special Instructions SubTotal 281.20
Note: Discounts reflected in unit pricing above. Tax 24.19
Shipping 0.00
Total 305.39
Payments and Credits 0.00
Financial Charges 0.00
Outstanding balance as 305.39
of 10/03/2016 in USD
https://finapprd.hg.hn-corp.com:9443/0A_HTML/OA.jsp?page=/oracle/apps/ar/hpa/templatemgmt/templates/webui/TmReal.. . 10/3/2016

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