Extracted text (via pymupdf_layout)
2862 characters
MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: November 6, 2015 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. e=" ;-›xl • The attached item has been researched to ensure the warrant in quation:,-, has not been cashed or previously re-issued. - >c_rq ")) - r. -7, :11 • The original warrant has a void/stale date/stop payment done. f , Please call me at 506-1329 if you have any questions. Please return the appitved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: POLARIS SALES, INC RECEIVED NOV 06 2015 çL MARICOPA COUNTY CLERK BOARD OF SUPERVISORS Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: 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 page 2 of this form. POLARIS SALES, INC (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 23-Feb-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/chc i esued him/her in the sum of $ 78,275.56 .(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) Subscrbed and sworn to before me this 5 11-- day of aoueni her- 20 i c. NOTAR PUBLIC My commission expires: Warrant/Check Number 350021140 (if known) (6) Original Date of Issue 23-Feb-2015 (if known) (7) Reason for original issue of Warrant/Check (8): MAPIICOPA OLrT LI Payroll 0 For Services or Goods furnished during the month of February, 2015 D Treasurer's refund/payment LI Other: g•A-1 AA'At 0 0.4 III I J 1 II) U) t rfll t'7.1 c'.1 ()AI r1 11: I t1:1 I K71 I (-) (7,1 t- (11 iii 471 ISTA1 Cl ft) Lii 0 if) I 1 Polaris Industries Inc, 2100 Highway 55 Medina, Minnesota 55340-9770 763-542-0500 763-542-0599 fax 11/12/2015 Polaris Sales, Inc. 2100 Highway 55 Medina, MN 55340-9770 Dear State if Arizona County of Maricopa: Peter Hoxmeier has the authority to sign for Polaris Sales, Inc. to request a new check for the outstanding balance. Regards, Amanda Rusin Assistant General Counsel