Extracted text (via ocr_local)
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v
MAR) COPA
COUNTY
Office of Budget & Finance To: Clerk of the Board
301 W. Jefferson St, 9*Floor From: Office of Budget & Finance, Accounts Payable
Phoenix, Arizona 85003
Date: 1-27-2025
Subject: Affidavit — Replacement of Lost Warrant
P: 602-506-3561
F: 602-506-4451
Please find attached one Affidavit for a lost warrant to be included on the next
Maricopa.gov 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 / D190-County Attorney/ vendor name : Annamarie Celaya
Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Oo Duplicate or E Stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
Annamarie Celaya (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 7125/2023 (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, @r it was not
presented for payment within pne 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 ¢405.66 (3)
an ;
Signed: A awrcene Cota iAg. (4)
Print name: (required) Annamarie Celaya’
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 |
[ vA / L “ ia “ A
NOTARY PUBLIC
Nora Chavire
Notary Public
Maricopa County, Arizona
. os see : My Comm. Expires 05-15-27
expires: J
My om veo ee Commission No. 652339
| 7
(seal)
Warrant/Check wumber 13010156481
Original Date of Issue 7/25/2023
Reason for original issue of Warrant/Check (8):
QO Payroll
C1 For Services or Goods furnished
O Treasurer's refund/payment
@ Other: Victim Compensation Check: 1941179-1-rqst 2&3
S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form)\100518 Warrants Checks notioe of claim.doc
Revised 100518 ARS. 11-632 & 11-644
RO p ~ WARRANT NUMBER a
PHOENIX; ‘ARIZONA “3010156481: ‘
DATE “ ,
07-25-2023 91-211291
a
fo,
Four Hundred Five And 66/100 Dollars tal
fp THE ORDER’ 2
w rie Celaya ae %
( Vold After}
ste { 365 Days / oe es
Z. \ aot a 5
% ‘, anamatll Sier aan 3
For Questions - 602-506-1379 of emai! AP@MAIL.MARICOPA,GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF #INANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
VICTIM WITNESS 3010156481 07/25/2023 $405.66
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO, AMOUNT
00000987346K ;1944179-1-rqst2 GAXIF D190 240000001293 398.54 CA
240000001293 t t
00000087346K 1941179-1-rqst3 GAXIF D190 2400000014283 7AZiCA
240000007 293