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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: December 8, 2015 DEC C 2015 To: Clerk of the Board .;OUNTY CLERK B0/1PL F SUPERVISORS From: Joyce Maurmann Department of Finance 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 item have been researched to ensure the warrant in question have not been cashed or previously re-issued. • The original warrant has a void/stale date/stop payment done. Please call me at 506-1343 if you have any questions. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960. Thank you. Re: Tara Downard-Wade Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or U 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 Page 2 of this form. Tara Downard-Wade (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 26-Aug-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 $ 90.00 .(3) Signed: I a-A.--)L--)L'—* (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was origMally issued. (5) Subscribed and sworn to before me this )\\ day of 20A. 11111 (MIA NOTARY PUBLIC Fe Val GRACE A TERRY My commission expires: Notary Public, State of Ohio 1)1N' .0111',. EXPIRES 02-15-*eal) k s Warrant/Check Number 360004993 110". if known) (6 Original Date of Issue 26-Aug-2015 (if known) (7) Reason for original issue of Warrant/Check (8): on 0 8 DAT LI Payroll LI For Services or Goods furnished RK mAn:c07',c BOARD f'_) SUPERVISORF. , D Treasurer's refund/payment Other: