STAMPED AND REDACTED - 3010232525 - TOM GUOBIS.PDF

To:        Clerk of the Board 
From:       Office of Budget & Finance, Accounts Payable 
Date:       4/29/2026 
Subject:  Affidavit ― Replacement of lost warrants 
 
Please find attached 1 Affidavit for a 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 is presumed lost and is stale dated. 
 
Please call Joyce Maurmann at 506-1343 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: Warrant 3010232525/Tom Guobis 
Fund 241 ― D300 GAX1D 26*10851 
 
Office of Budget & Finance 
301 W. Jefferson St., 9th Floor 
Phoenix, Arizona 85003 
 
 
P: 602-506-3561 
F: 602-506-4451 
 
Maricopa.gov

MAR
COPA 
COUNTY 
Application for a Duplicate or Stale Dated
Warrant/Check Affidavit/Claim Form 
This application is for I II' I Ouplicate or D Stale-Dated (definitions are on page 2)
STATE 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 
_li_o _m _G_u_o_b_is ____________ (1 ), being first sworn, upon oath deposes and says:
Name/Claimant 
On or about _1 _12_8_12_6 _____ (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 issued to him/i:w in
m
$ 150.00 
. {3) 
Signed: ^ 7
(4)
Print Nam_ _li_o _m_G_uo_b_is _____________ 
_
Note: Please attach a copy of the warrant/check if available and/or any other evidence that a
warrant/check was originally issued. 
NOTARY PUBLIC 
My c9mmission expires: 
21 a--r ZL>u: 
Warrant/Check Number
(if known) (6)
Original Date of Issue
(if known) (7) 
3010232525
1/28/26
Reason for origi,nal issue of Warrant/Check (8):
□Payroll _________________________ 
_
□For Services or Goods furnished _________________ _
□Treasurer's refund/payment __________________ 
_
0 Other: Refund Parks / fund 241 /D300/GAX1 D 26*10851
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\ 100518 Warrants Checks notice of claim.doc Revised 
100518