STAMPED & REDACTED-KENNETH BROWN.PDF

MAR COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson-St., 9" Floor
Phoenix, Arizona 85003

P: 602-506-3567
F: 602-506-4451

Maricopa.gov

Ta: Clerk of the Board

From: — Office of Budget & Finance, Accounts Payable
Date: 08.26.25

Subject: Affidavit — KENNETH BROWN

Please find attached one Affidavit for a Duplicate Dated warrant to be included on the
next available Board Agenda.

e 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, 9" Floor.

Thank you.

Re: D750-RISK MANAGEMENT-FUND 675 — GAX1D 26*2321-FY26 WC277025024096 BROWN

MA R} C OPA Application for a Duplicate or Stale Dated

COUNTY Worrant/Check Affidavit/Claim Form
This application is for lv] Duplicate or L] Stale-Dated (definitions are on page 2)
STATE OF ARIZONA | Note: Numbers on this form correspond to the numbers
COUNTY OF MARICOPA jon the Instruction sheet which Is is * page 2 0 of this form |
KENNETH BROWN (1), being first sworn, upon oath deposes and Says:

Name/Claimani
On ar about 13-AUG-2025 (date) (2) a warrant/check was issued to the above nameri
person/entity iw the amount 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 ai presented for payment, or It was not presented for payment within one year
after the date of issuance

therefore, under penalty of perjury, claimant herehy affirms that this claim is correct and the
amount shown is due and owing, and the applicant requests that a replacement warrant/check
be issues to him/her in the sym of $3,625.06 0 (3)

de

Signed: a in : ae

Pian Name Gena, Merch £ Eye. G ets Yew ee

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 ong spatore me this 26m day of Aigy ot 20257

i NOTARY PUBLIC SS eran i
i TANNER PLITZUWEIT i
i NOTARY PUBLIC - ARIZONA | i
: __ {Maricopa County ? ;
: My commission expires: CNS 12 tAy Commission Expires i seal) |
June 49% 2024 ‘une 38,2028
Warrant/Check Numb |
Herant/Gheck Number 3910219607
Original Date of Issue aa AL ny
. rere ors 13-AUG-2025
8/26/25
Reason for original issue of Warrant/Check (8). / a /26/
Ci Payroll

0 For Services or Goods furnished ___

CO Treasurer's refund/payment 0
ED Other, D780-RISK MANAGEMENT-FUND 675-GAX1D 26°?)

3 BROWN

Ss ARHOCE SSE GW Wareant
HODo TE

COUNTY EXPENSE WARRANT

és

OoNt

Sere
Ee!
QO Br

TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

PAY TO THE ORDER OF
KENNETH BROWN

For Questions - 602-506-1379 or email AP@MATI.MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF FINANCE

DATE

WARRAN

TT NUMBER

3010219607

P| —_

Three Thousand Six Hundred Twenty Five And 06/100 Dollars

Void After
365 Days

$3,625.06

AMOUNT

NOT NEGOTIABLE

RETAIN THIS FOR | PAYER

YOUR RECORDS

WARRANT NO. | WARRANT DATE | WARR.

ANT AMOUNT

812BROW

FY26 WC277025024096 BROWN 07/14/25 - 08/1!

260000002321

SETTLE 3010219607 08/13/2025 $3,625.06
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
GAX1D D750 260000002321 3,625.06

PU

Warrant number — Issued date Paid date Amount

2025 12:0000am 625,08)

12000 3010219607

» Warrant aumben

cea
a

Amount Payee Account

KENNETH BROWN PY