080316 DUPLICATE WARRANTS 7 - FINANCE_REDACTED.PDF

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CLERV.
MARICOPA COUNTY BOARD OF SUPER\IISOR'S Y
Department of Finance HARICOT' A COIltil
301 West Jefferson, Ste 960 21116 20 P1-111: 20
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: July 20, 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: Mahad D Abshir

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
paae 2 of this form.
MAHAD ABSHIR (1), being first sworn, upon oath deposes and says:
Name/Clamant
On or about 22-Apr-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/ch ueci- tcr-kiim/her in the sum of $ 397.25 .(3)
(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 )--V\Ci day of —TO k/
NOTARY PUBLI 7-4k\--17F1-7 ABDI YUSUF
Notary Public
In and for the State of Ohio
My commission expires: My Commission Expires
I -Lx. November 03 kseai) 2,0120
Warrant/Check Number 360024424
(if known) (6)
22-Apr-2016
Reason for original issue of Warrant/Check (8):
O Payroll
BOARD OF SUPERVISOR
D For Services or Goods furnished MARICOPA COUNTY
- -
O Treasurer's refund/payment
O Other:
I FREdElIVED
I JUL 07 20I5

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10
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1,4 171

Li fr dieL
CLERK
MARICOPA COUNTY BOARD OF SUPERVISOR'S
Department of Finance F1ARICOP A COUH1
301 West Jefferson, Ste 960 2016 JUL 20 At'll 1: 20
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: July 20, 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: Nina Nichole Johnken

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
Pape 2 of this form.
Nina Nichole Johnken (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 22-Mar-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 sbown is due and owing, and the applicant requests that a replacement
warrant/check of $ 208.00 .(3)
(4)
Note: Please attach copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
(5) Subscrib.d and swornto,before me this O day of jU) y 20 I le .
NOTARY PUBLIC
KATHARINE PETERSON
My commi4on expires: Notary Maricopa Public County - Arizona
0 .11)21 I °) My Comm. Expires Jul 12, 20AI)
Warrant/Check Number 360021635
(if known) (6)
Original Date of Issue 22-Mar-2016
(if known) (7)
Reason for original issue of Warrant/Check (8): JUL 2 0 2016
"
El Payroll
0 For Services or Goods furnished
CI Treasurer's refund/payment
0 Other: Court refund

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