STAMPED AND REDACTED - 3010209376 -KAELA MAICA AVILA.PDF

To:        Clerk of the Board 
From:       Office of Budget & Finance, Accounts Payable 
Date:       3-16-2026 
Subject:  Affidavit ― Replacement of Lost Warrant 
 
Please find attached one 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 Walter Chang at 506-8747 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:  Fund : 532  /  Public Health Dept / vendor name : Kaela Maica Avila 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Office of Budget & Finance 
301 W. Jefferson St., 9th Floor 
Phoenix, Arizona 85003 
 
 
P: 602-506-3561 
F: 602-506-4451 
 
Maricopa.gov

Application for a Duplicate or Stale-Dated Warrant/Check 
Affidavit/ Claim Form 
This application is for: 0 Duplicate or D 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 
paqe 2 of this form. 
_K_a
-r::
e=l
-::-:
al'7"<"M§a_ic-.-a_A_v_il_a _____ (l), being first sworn, upon oath deposes and says:
Name/Claimant 
On or about 07-Apr-2025
(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/check be issued to him/her in the sum of $_2_,5_0_0_.0_0 _______ .(3)
Note: Please attach a copy of the warrant/check if available and/or any other 
evidence that a warrant/check was originally issued. 
(5) Subscrib d and sworn to before me this _/_cl __ day of f1 ifc),
NOTARY PUBLIC 
My commission expires: 
3-/3 -
 
Warrant/Check Number 
tf knovJn 
6
Original Date of Issue 
if known 7 
GERI FIT!GERALD 
: 
Notary Publ!c • Arizona 
• .... · 
' ;i
M.aricopa Coonty 
),I 
Commksfon /1662259 
• ,,,1 
• 
My Comm. ;Ires MM 1 l, 2028 
000003010209376 
07-Apr-2025 
Reason for original issue of Warrant/Check (8): 
D Payroll 
0 For Services or Goods furnished Participant Costs, Stipends
20 :l&.
(seal) 
D Treasurer's refund/payment ________________ _ 
□Other:
, ________________________ _