STAMPED AND REDACTED - 3010237638 - JAY DRAKE.PDF

To:        Clerk of the Board 
From:       Office of Budget & Finance, Accounts Payable 
Date:       04/28/26 
Subject: Affidavit – JAY DRAKE 
 
Please find attached one Affidavit for a DUPLICATE 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 is presumed lost. 
 
Please call Marcia Anderson at 506-7291 if you have any questions. Please return the 
approved Affidavit to my attention in the Office of Budget and Finance, 9th Floor. 
 
Thank you. 
 
 
 
Re:  D750 RISK MANAGEMENT – FUND 675 – GAX1D 26*14659-WC113019004881 
DRAKE TTD= 3/18/26 – 3/29/26  
 
Office of Budget & Finance 
301 W. Jefferson St., 9th Floor 
Phoenix, Arizona 85003 
 
 
P: 602-506-3561 
F: 602-506-4451 
 
Maricopa.gov

MARCOPA 
COUNTY 
Application for a Duplicate or Stale Dated 
Warrant/Check Affidavit/Claim Form 
This application Is for [l) Duplicate or D Stale-Dated (deflnftiona are on page 2)
ST ATE OF ARIZONA 
COUNTY OF MARICOPA 
Note: Numbers on this form correspond to the numbers 
on the Instruction sheet which Is page 2 of this form 
_J_A_Y_D_RA_K_E_.....,..,.,...,.. _________ (1 ), being first sworn, upon oath deposes and says:
Name/Claimant 
On or about 30-MARCH-2026 
(date) (2) a warrant/check was issued to the above named
person/entity in the amount 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 issues to him/her in the sum of$ 927.24
. (3) 
Signed:ęĚ
(4) 
Print Name: (required) .....:;;;5. 
.... 4
..:.+
,;,---R..1.csJ
_..,<..._ě 
____________ _ 
Note: Please attach a copy of the warrant/check if available and/or any other evidence that a 
warrant/check was originally issued.
My commission expires: 
oz./11:5 I Wh '-if-
F 
I 
Warrant/Check Number 
(if known) (6) 
Original Date of Issue 
(if known) {7) 
3010237638 
30-MARCH-2026
Reason for original issue of Warrant/Check (8): 
MICHELLE M. CREWSE
Notary Public • State of Arizona
MARICOPA COUNTY 
Commission#v 
Expires February 25, ut?al 
□Payroll ________________________ _
□For Services or Goods furnished _________________ _
□Treasurer's refund/payment __________________ _
@ Other: O750-RISK MANAGEMENT- FUND 675-GAX1O 2s•t4659-WC113019004881 DRAKE TTO = 3/18/26-3/29/26 
S:\PROCESSES\Warrants- Duplicate or stale\02 Forms\Current Claim Form\ 100518 Warrants Checks notice of claim.doc Revised 
100518 
ARS.11-632&11-644