STAMPED AND REDACTED - FOR AGENDA ATTACHMENT - 3010222849 - KATINA CASTILLO.PDF
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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. _K_a_t_in_a_C_a_s_t_il_lo _______ (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 9/24/2025 (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 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 Warrant/Check Number if known 6 Original Date of Issue if known 7 3010222849 9/24/2025 Reason for original issue of Warrant/Check (8): □Payroll DANA CORONA Nolary Public - Stale of Arizona MARICOPA COUNTY Commission# 662105 fapires February 29, 2028 (seal) □For Services or Goods furnished, _______________ _ □Treasurer's refund/payment ________________ _ l!!!l other: VC1997292-1-rqst3 reissue CFu< ;:: r: 2 l @ ·7 / ), 1 Fvi, ¡ I r1 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