062216 DUPLICATE WARRANTS - 11 - FINANCE.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: June 16, 2016
To: Clerk of the Board Z ..
From: Walter Chang
Department of Finance 0"1
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 1 Affidavits for lost warrants to be included on the next available
Board Agenda.
• The attached items have been researched to ensure the warrant in
question have not been cashed or previously re-issued.
• The original warrants have a void/stale date/stop payment done.
Please call me at 506-8747 if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.
Thank you.
Re: C.B. Contracting, Inc

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: 1 Duplicate or 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
Dade 2 of this form.
C.B. CONTRACTING, INC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 02 -Feb -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/check be issued to him/her in the sum of $1,320.00 .(3 )
Signed: (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 /04 day of (-11AA-J.-- 20 I ia .
NOTARY/ PUBLIC :221:22za,mtaekseeeeet
OFFICIAL SEAL
JuDENE BROWN
My commission expires: NOTARY MARICOPA PUBLIC COUNTY - ARIZONA
Vi5/7-0/ My Comm. Expires 08-13-2016 (seal)
Warrant/Check Number 00360017464
(if known) (6)
Original Date of Issue 02-Feb-2016
(if known) (7)
Reason for original issue of Warrant/Check (8):
O Payroll
O For Services or Goods furnished
O Treasurer's refund/payment
Other: warrant lost in mail / never received
A PPV IL
JUN. 6 2016
17TC-Aa ARO-0'F S
rs4AR!OOPA COUNTY

Instructions for completing the AFFIDAVIT/CLAIM FORM
Regarding a request for either a
DUPLICATE or STALE-DATED WARRANT/CHECK
"Duplicate" is a check or warrant that has been lost, destroyed or never received within
one year of the issue date.
"Stale-dated" is a check or warrant that has not been cashed within one year of the
issue date.
O Instructions: (numbers correspond to numbered blanks in the form)
(1) Print name of the person making the affidavit/claim statements (See NOTE re:
Business if the name is a representative of a business or other organization.)
(2) Date the original warrant was issued, or approximate date if actual is not known.
(3) The amount in figures (ex: $1,000.25) (Please print clearly.)
(4) Signature of the Claimant (be sure to sign in the presence of the Notary Public).
(5) This box to be completed by the Notary Public.
(6) If known, the number of the warrant or check
(7) If known, the exact original issue date of the warrant or check
(8) Check the appropriate box below for the reason for the warrant or check. If the
appropriate reason is not listed, check "Other" and explain.
O Please attach the original warrant/check or a copy of the warrant/check if available.
O Note re: Business or other organization/entity — If the signer of the affidavit/claim
form is the representative of an entity rather than an individual, please provide a
document on entity letterhead designating the signer as authorized to sign for the
entity.
O Additional required information for Stale-dated check/warrant claims:
You must provide a statement and/or other documentation demonstrating that there
is good and sufficient reason for the failure to present the original check or warrant
for payment within one year of its issuance.
Below are relevant Arizona Revised Statutory references regarding issuing duplicate
warrants and Stale-dated warrants or checks. (statutes as of April 2014)
Duplicate Warrant:
11-632. Issuance of duplicate warrant
A. When it appears to the satisfaction of the board or county school superintendent by
affidavit or otherwise that a warrant on the county treasurer has been lost or destroyed
prior to payment and there is no reasonable probability of its being found or presented,
the board may direct the issuance to the owner of a duplicate of the lost or destroyed
warrant. Before issuing the duplicate, however, the board or county school
superintendent shall send a written stop payment notice to the county treasurer, giving
the number, amount and date of the warrant, the payee and the fund on which drawn.
Such duplicate warrant issued under authority of this section shall constitute full and
Revised: April 2014

sufficient authority to the county treasurer for disbursement of public monies in the
amount set forth on the duplicate warrant. The county treasurer shall not pay any
warrant on which a stop payment notice has been made unless the board has released
the stop payment in writing.
B. The board of supervisors shall establish procedures for issuing duplicate warrants
that protect the county and provide the owner with a duplicate warrant within a
reasonable time.
Note regarding STALE-DATED WARRANTS
The Arizona Revised Statutes do not provide for re-issuance of a warrant beyond two
(2) years from the date of issuance. Please see ARS 11-644 below.
Stale-Dated Warrant
11-644. Failure to present county check or warrant for payment
A. A check that is drawn by the county treasurer in the treasurer's official capacity or a
warrant that is drawn on the county general fund and that is not presented for payment
within one year after the date of issuance is void, is deemed to have been paid and is
not subject to section 44-302. A check or warrant that is not presented for payment
within one year has no further force or effect and any monies shall be transferred or
revert to the county general fund or other appropriate fund.
B. At any time within one year after an unpresented check or warrant has been voided
as provided in subsection A of this section, the person in whose favor the check or
warrant was drawn, or the person's personal representative, successors or assignees,
may present a claim for the amount of the check or warrant to the board of supervisors.
If the board finds that the claim is legitimate and that there is good and sufficient reason
for failure to present the original check or warrant, the board may allow the claim and
order it to be paid from the county general fund or other appropriate fund.
Revised: April 2014

Ph: 480-830-1272 Fax: 480-830-5403 44 N. Slap ley Dr Mesa, Al 85203
Beth Brown,
This is to inform you that Lee Ann Watkins is an authorized signer for K12 Defense/CB Contracting.
Date