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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: February 11,2016 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: CALAMP Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 151 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 pacie 2 of this form. CALAMP (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 20-Nov-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/check be is to him/her in the sum of $ 5,400.00 .(3) Signed: e:=YY"-- C,4-M-0.4/4 (4) lrev/ Note: Plea e 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 9 day of 20 1". . EVERARDO CANCINO .•01.,v Commission # 2086938 , 1 Notary Public - California 1 V'"PT, _ m x rta.Cr ounty _ My commission expires: Comm. Ex ires Oct 20, 2018 1 01 al, 10,01 (seal) Warrant/Check Number 360012048 (if known) (6) Original Date of Issue 20-Nov-2015 (if known) (7) Reason for original issue of Warrant/Check (8): El Payroll is For Services or Goods furnished during the month of November, 2015 111 Treasurer's refund/payment El Other: February 8, 2016 Maricopa County Department of Finance Attn: Beth Brown 301 W Jefferson, Suite 960 Phoenix, AZ 85003 Re: Application for a Duplicate or State-Dated Warrant/Check Affidavit/Claim Form Dear Beth, This is to confirm that Tim Wiebelhaus, Manager of Credit and Collections for CalAmp, is authorized to sign the attached Affidavit/Claim form for replacement check of warrant 360012048, $5400.00 Sincerely, J4 Bates Corloorate Controller CalAmp CalAmp 19144 Van Ness Avenue, Torrance, CA 90501 ot. ft', FIVE THOUSAND FCZIR HUNDRED DCLLARS AND 0 (110 0 CiL- .1 9 n_.q 4 VAN NE 55 VE CA 90.501 77117 7: CR. IN5TALL—C3AL S YST EM 1E 2' :A , 4 00 . 00