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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: December 10, 2015 To: Clerk of the Board From: Joyce Maurmann Department of Finance Subject: Notice of Claim — Replacement of Stale dated warrant Please find attached 1 Notice of Claim for stale dated warrant to be included on the next available Board Agenda. e The attached items have been researched to ensure the warrant in question have not been cashed or previously re-issued. e The original warrant is stale dated. 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: Security Title Agency RECEIVED DEC 18 2015 MARICGPA COUNTY CLERK _ BOARD CF SUPERVISORS hand delivered 2 Cc Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: CO Duplicate or Stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the Instruction sheet which is COUNTY OF MARICOPA page 2 of this form Security Title Agency (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 09-Oct-2014 (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 to him/her in the sum of $ 1,051.02 (3) rarer 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 ahd sworn to before me this _ 2015. NOTARY PUBLIC Mansion Epica My commission expires: > 9d Wi <7 Warrant/Check Number 8 1 4383 (if known) (6) Original Date of Issue Reason for original issue of Warrant/Check (8): © Payroll © For Services or Goods furnished payment not intended for MC Treasurer Treasurer's refund/payment 0 Other: SECURITY TitLe AGENCY ADMINISTRATION 3636 N. Central Avenue Suite 140 ¢ Phoenix, Arizona 85012 Phone 602.266.3298 # Fax 602.230.6209 December 9, 2015 Maricopa County Treasurer RE: Warrant Ck#814383 in the amount of $1,051.02 To Whom It May Concern: This letter is to inform you that Kristine Osborn is authorized to sign said Affidavit/Claim form on behalf of Security Title Agency. If you need any additional information you may contact me at 602-230-6230, Sincerely, SECURITY TITLE AGENCY aa F Debbie Tucker Vice President