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RECENED MARICOPA COUNTY FEB 19 2016 Department of Finance mARicop:=, 301 West Jefferson, Ste 960 CLERK BOARD OF ;i .eirDERVSSORS Phoenix, Arizona 85003 / (//1-tik_AS INTEROFFICE MEMORANDUM Date: February 19, 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: INVESTIGATIVE RESOURCES Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 151 Duplicate or 111 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. Investigative Resources (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 04-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 issued to him/her in the sum of $ 1,204.40 .(3) Signed: eA -(71 (6 Lt. . (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 swop to before me this day of — 20 / . NOTARY PUBLIC, MARIE L. FITZSIMMONS Notary Public - State of Arizona My commissipn expires: My MARICOPA Commission COUNTY Expires d ' 1 May 25, 2019 (seal) / Warrant/Check Number 360010666 (if knoWn) (6) Original Date of Issue 04-Nov-2015 (if known) (7) Reason for original issue of Warrant/Check (8): D Payroll For Services or Goods furnished invoice#6160 D Treasurer's refund/payment D Other: INVESTIGATIVE RESOURCES SERVICE, L.L.C. fly 24 WEST CAM ELBACK RD If 539 PHONE (602) 254-9899 PHOENIX, ARIZONA 85013 FAX (602) 254-9906 February 29, 2016 To Whom It May Concern: Re: Affidavit for Application for a Duplicate or Stale-Daded Warrant/Check I appreciate the County for willing to reissue a check for $1,204.50 as stated on the above Affidavit/Claim Form for my company. I am the owner and director of Investigative Resources Service, LLC, and have been in this position since 1986. Should you have any questions please feel free to call me at (602) 254-9899. Thank you for your kind assistance in this matter. Very Truly yours, Owner, Investigative Resources Service, LLC Arizona License 1000896 Email patsha@qwestoffice,net