STAMPED AND REDACTED - 3010227402 - MCCARTHY HOLDINGS INC.PDF

To:        Clerk of the Board 
From:       Office of Budget & Finance, Accounts Payable 
Date:       2/26/2025 
Subject:  Affidavit ― Replacement of lost warrants 
 
Please find attached 2 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. 
 
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. 
 
 
 
Warrant  #3010227402 - McCARTHY HOLDINGS INC 
Fund 232 ― D640 GAX1D 260000007461 - $25,202.84 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Office of Budget & Finance 
301 W. Jefferson St., 9th Floor 
Phoenix, Arizona 85003 
 
 
P: 602-506-3561 
F: 602-506-4451 
 
Maricopa.gov

l
MARlCOPA 
COUNTY 
Application for a Duplicate or Stale Dated 
Warrant/C,heck Affidavit/Claim Form 
Thisapplication is for 
I✓ I Duplicate 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 
_M_c_C_A_R_T_H_Y_H _O_L_D_IN_G_S_IN_ C _______ (1), being first sworn, upon oath deposes and says: 
Name/Claimant 
On or about _1_1_/2_6_/2_5 _____ (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 pres—nted 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/her in the sum of $ 25,202.84 
. (3) 
Signed: , Q-.<: 
 
(4) 
Print Name: (required) __ 
....;!)o
;;...;;....,,_ 
.. _;_J,o_....;J..,,.,..
;,;,,,_t:)...,_ _________ _ 
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 and sworn to before me this I D t,,. day of t'Y)  20+
N;K {,  
My c9r1missio1Jcpires: ,· r::,. 
') D 3D
0cvv\.J..,l% ot / 7 o'-
Warrant/Check Number 
• 
(if known) (6)
Original Date of Issue 
(if known) (7) 
3010227402 
11/26/2025 
Reason for original issue of Warrant/Check (8): 
CHRISTY BROOKS 
Notary Public - Arizona 
Maricopa County 
My Commission Expires 
January 27, 2030 
Commission # 
□Payroll ___________________________ _
□For Services or Goods furnished __________________ _
□Treasurer's refund/payment ___________________ _
0 Other: Release cash bond/ G AX1 D 26*7461 I FUN D 232 
S:\PROCESSES\Warrants • Duplicate or Stale\02 Forms\Current Claim Form\ 100518 Warrants Checks notice of claim.doc Revised 
100518