042016 DUPLICATE WARRANTS - 4.PDF

MARICOPA COUNTY
Department of Finance
301 West Jefferson, Ste 960
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: April 1,2016
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: TruWest Credit Union
AP 1 2016
LIMN
CLERK BOAR , 17-- SUPERVISORS

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
Dade 2 of this form.
Alysse M. Medina attorney for TruWest Credit Union (1) / being first sworn, upon oath deposes and says:
Name/Claimant
On or about 19-0ct-2015 (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/checl, be issued to him/her in the sum of $ 503 .25 .(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 I-3 day of ftertit 20!(c .
NO Y PUBLIC
Notary Public State of Arizona
My_coirnmitssion expires: Maricopa County
/ IC) 9- Elizabeth My Commission Luna Expires 12/1012017 (seal)
Warrant/Check Number 00360009430
(if known) (6)
Original Date of Issue 19-Oct-2015
(if known) (7)
Reason for original issue of Warrant/Check (8): DAT51 AP 042
111 Payroll RK. BOARD OF SUPERVISORS
111 For Services or Goods furnished Vo,71C9FA COUNTY
LI Treasurer's refund/payment
Other: Wage Garnishment

201 N. Central Avenue Mw
22nd Floor POTENZA
Phoenix, AZ 85004-0608
Direct Dial: 602-774-3549 BARAN
Facsimile: 602-252-1114 ("(
ALYSSE M. MEDINA amedina@maypotenza.com GILLESPIE
ATTORNEY AT LAW www.maypotenza.com
April 1, 2016
Maricopa County Department of Finance
and Accounts Payable
Attn: Beth Brown
301 West Jefferson Street, Suite 220
Phoenix, Arizona 85003
Re: TruWest Credit Union/Benjamin Anderson
Case No. CV2010-033037
Beth:
Please see the attached Application for a Duplicate or Stale-Dated
Warrant/Check Affidavit/Claim Form regarding the replacement of check no.
0036009430 dated October 19, 2015.
I am the attorney for TruWest Credit Union in this matter and I am
authorized to sign this Affidavit on their behalf.
If you have any questions, please contact our office.
Sincerely,
MAY, POTENZA, BARAN &
GILA,tSPIE, P.C. ,
Alysse M. Medina, Esq.
Enclosure

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