REDACTED FOR AGENDA ATTACHMENT- 1963648 - FALCONEYE VENTURES, LLC.PDF

John M. Allen, Treasurer
301 West Jefferson St., Rm. 100
Phoenix, Arizona 85003
Phone: (602) 506-8511
http://treasurer.maricopa.gov
To: Clerk of the Board
clerk.agenda@maricopa.gov
Dorene.Stretar@Maricopa.Gov
From: Treasurer’s Office
Katelyn Hale
katelyn.hale@maricopa.gov
602-506-3357
Cathy Sanchez
cathy.sanchez@maricopa.gov
602-506-7881
Re: Stale Dated Warrant
Name Warrant Amount Dept/School
No
FALCONEYE VENTURES LLC 1963648 $28,335.24 Treasurer

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: D Duplicate or l;ZI Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
David Megdal, ManagerofFalconEyeVenlures, LLC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 5108125 (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
the sum of $_2 _8_,3 _35_.2_4 _______ .(3)
Print na e: (required) David Megdal, Manager of FalconEye Ventures, LLC
Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
d sworn to before me this \4 -t\'I day of f)eµtem\:'Pr: 20.2£.._.
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8
Notary KELLY Public, SEIBERLICH Steto of Arizona
My commission expires: Mtricopa County
8J◊/202q My Commission Commission t 688018 EKplres (seal)
Au ust03.2029
Warrant/Check Number
If known 6) 1963648
Original Date of Issue
If known 7 5108125
Reason for original issue of Warrant/Check (8):
□Payroll
□For Services or Goods furnished ----------------
d Treasurer's refund/payment------...,..----------­
'Ill' Other: Tax Lien Certificate Purchase
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc
Revised 100518 A.R.S. 11-632 & 11·644
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