STAMPED & REDACTED-STEPHAN BANKOSZ.PDF
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SOUR ~ a MARICOPA 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: 05.20.25 Subject: Affidavit — STEPHAN BANKOSZ Please find attached one Affidavit for a Duplicate Dated 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 Bulanda 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: FUND 100 ~ D240 JUSTICE COURTS— GAX1D 25*1377 ~ REQUEST FOR REFUND GRANTED - DDS COMPLETED/ CT2024177428 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or (] Stale-Dated (efinitions are on page 2) STATE OF ARIZONA Note: Numbers: on this’ form correspond fo COUNTY OF MARICOPA numbers on the instruction sheet which is . nade, 2 of this form. STEPHAN BANKOSZ (1), being first sworn, upon oath deposes and says: Narme/Ciaimant . On or about 25-Mar-2025 (date)(2) @ 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 ne 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 issued to him/her in the sum of g 931 08 (3) me * Signed ae Ya hat es (4) Note. Please .attach a copy of the watrant/check if available andjer any other evidence that a -warrant/check was originally issued. (5) Subscribed and:swern to before me this oT day of Mah 20265. \ Wind) i NOTARY PUBLIC. AER SUSAN MAMES 7 fag ow Notary Public - Arizona a Ez Maricopa County Ss eS Commission # 614127 r 18 My commission expires: Wiauer 26, 2D2S SEE My Comm. Expires Aug 26, 2025 Wi t/Check Numb: OS arran sCneck on _- 3010208452 Original Date of Issue A9 if | 5 UPenowny 26/03/2025 ny Reason for original issue of Warrant/Check (8): C1 Payroll Ae] For Services or-Goods furnishe q Retuest for refund granted ~ DDS sompleted./CT2024177428 Cl Treasurer’s:refund/payment Other: / check presumed lost / fund : 400-,. initiated by the dept COL TY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER <cs PHOENIX, ARIZONA 3010208452 Bie, © ARTE NN 91-2221 OUNTS Three Hundred Thirty One And 58/100 Dollars $331.58 PAY TO THE ORDER OF AMOUNT Stephan Bankos Void After 365 Days NOT NEGOTIABLE For Questions - 602-506-1379 or email AP@MATI.MARICOPA.GOV MARICOPA COUNTY DEPARTMENT OF FINANCE RETAIN THIS FOR | PAYEE WARRANT NO, | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS MREFUND 3010208452 03/26/2025 $331.58 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT C72024177428 Desert Ridge Justice Courts GAX1D D240 250000013777 331.58 250000013777 List “¢ issued warrarrts (Unsayed [] Agency Status Warrant number — Issued date Paid date Amount + Issued 3010208452 | ¥ © - 12000. Issued 3010208452 3/26/2025 12:00:00 am 7 331.58; Warrant nurober 3010208452 Amount Payee Account 331.58 Stephan Bankosz