STAMPED & REDACTED - GARY CHRISTENSON.PDF
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v MAR) COPA COUNTY Office of Budget & Finance 301 W. Jefferson St., 9* Floor Phoenix, Arizona 85003 P: 602-506-3561 F: 602-506-4451 Maricopa.gov To: Clerk of the Board From: Office of Budget & Finance, Accounts Payable Date: 1-23-2025 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. e 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, 9" Floor. Thank you. Re: Fund 219 / County Attorney — D190 / Gary Christenson Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or [1 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 paae 2 of this form. Gary Lee Christenson _ (1), being first sworn, upon oath deposes and Says: Name/Claimant On or about 22-Oct-2024 (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 cf 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 ¢607.84 (3) Signed: A an Zoe. Chilo (4) Note, Please attach a copy of the wartant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this 0 b day of Januaty 2025 . v NOTARY PUBLIC RYAN MINK MARIGOPACCOUNTY My commission expires: Commission OL / i g | 202K Expires February 19, 2028 } (seal) Warrant /Check wamber 10000030101 95896 Original Date of Issue ne known) () 22-Oct-2024 Reason for original issue of Warrant/Check (8): 1/23/25 O1 Payroll : : U1 For Services or Goods furnished (1 Treasurer’s refund/payment Other: Victim Compensation Check: 2041088-1, req #2, 3, 5, 6 COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZONA 3010195896 DATE a Six Hundred Seven And 84/100 Dollars $607.84 PAY TO THE ORDER OF AMOUNT Gary Christenson i Void After H 365 Days For Questions - 602-506-1379 or email AP@MAIL-MARICOPA.GOV NOT NEGOTIABLE MARICOPA COUNTY DEPARTMENT OF FINANCE RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS VICTIM WITNESS 3010195896 10/22/2024 $607.84 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT (00000071480K 2041088-1-rqst2 GAXIF D190 250000009647 121.50/CA 250000008647 00000071480K 2041088-1-rqst3 GAXIF D190 250000008647 387.80)CA 250000009647 00000071480K 204 1088-1-rqst5 GAXIF D199 250000009647 28.54|CA 250000009647 00000071480K 204 1088-1-rqsté GAXIF D190 250000009647 70,00|CA 250000009647