STAMPED AND REDACTED - 3010217599 - JAMAL AVERY.PDF

To:        Clerk of the Board 
From:       Office of Budget & Finance, Accounts Payable 
Date:       03/05/26 
Subject: Affidavit – JAMAL AVERY 
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:  D190-COUNTY ATTORNEY – FUND 219 – GAXIF 26*01463 – VC2074396-1-RQST3 
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: !!I Duplicate or D Stale-Dated (definitions are on page 2)
STATE OF ARIZONA 
COUNTY OF MARICOPA 
Note: Numbers on this form correspond to numbers on the 
Instruction sheet which Is page 2 of this form, 
_J_a_m_a_l A_v_ery _______ ,(1), being first sworn, upon oath deposes and says: 
Name/Claimant 
On or about 07-18-2025
(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 issu d to him/her in th sum of $_3, 5_2_8_.0_0 ______ .(3) 
Print name: (requi ed) 
'J0/4,'>f t:s;'\f'Q..,, v' L/
Note: Please attach a copy of the warran{check if available and/or any other 
evidence that a warrant/check was originally issued 
and sworn to before me this:K&hJ day of Tue,, , 
2oo>-S . 
Warrant/Check Number 
if known 6 
Original Date of Issue 
if known 7 
3010217599 
07-18-2025
Reason for original issue of Warrant/Check (8): 
□Payroll
J iilTIERM0fl 
NOTARY PUii.iC • AlltZONA 
MAR100PA COUNlY 
COMMt88ION # 178844 
MV COMMISSION EXPIRES 
FE8AUAIIYOIS 11111 
(seal) 
□For Services or Goods furnished, _______________ _
D Treasurer's refund/payment ________________ _
liol Other: VC207 4396-1-rqst3 -1) I '1 o C'° urll· y P<l+orne '{ - f u,10 J i'J
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc 
Revised 100518 
(6 P, ')( I V ;), I:) f-G \ lj I, 3
ARS, 11-632 & 11-644