STAMPED & REDACTED - PAM IPPEL.PDF

MAR! COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St, 9" Floor
Phoenix, Arizona 85063

P: 602-506-3561
F: 602-506-4451

Maricopa.gov

To: Clerk of the Board

From: Office of Budget & Finance, Accounts Payable
Date: 05.22.25

Subject: Affidavit — PAM IPPEL

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.

e 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 241 — D300 PARKS & RECREATION ~ GAX1D 25*12059 — INV#2097080-INV#2121591-
INV#2121603

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/ Claim Form

This application is for: Duplicate or LJ 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
page 2 of this form.
PAM Usa=s (1), being first sworm, upon oath deposes and says:
me/Claim:
On or about 28-Jan-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 amouni shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $98.00 (3)

= (4)

Note; Please attach a a copy of the warrant/check if available and/or any other
evidence that a watrant/check was originally issued.

(5) Subscribed and sworn to before me this 22 uay of YIAE f_ 20.25,

abt PUBLIC ‘ oe
EWA!

My commission expires: byaerte
Dae {av2e an Ss (seal)

NOTARY PUBLIC - State of Kansas

WwW: Check Numbe:
ae [3010203702

Reason for original issue of Warrant/Check (8): j 5/22/25
J Payroll ig
© For Services or Goods furnished OC

O Treasurer’s refund/payment
[a Other. Fund 241- oe PARKS & RECREATION - GAX1D 25°12059 - “INvezno7080- INVEZI 216 2121003

COUNTY EXPENSE WARRANT

Five Hundred Seventy Eight And 00/100 Dollars

PAY TO THE ORDER OF
Pam Ippel

For Questions - 612-506-1379 or email AP@MAIL MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF

TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

DATE
61-28-2025

Void After
365 Days

WARRANT NUMBER
3010203702

91-2/1221

$578.00

AMOUNT __

NOT NEGOTIABLE

RETAIN THIS FOR | PAYEE.

YOUR RECORDS

WARRANT NO, | WARRANT DATE

WARRANT AMOt i

250000012059

INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT |

2097080 Refund Sale #2097080 GAX1D D300 250900012059 438.00
250000012059

2121591 Refund Sale #2121591 GAX1D D300 250000012059 118.00
250000012059

2121603 Refund Sale #2121603 GAX1D D300 250000012059 22.00

“? issuect wal rec] foteri +
(] Agency) Status Warrant number Issued date Paid date Amount
vq Issued ~ v ¥

“12:00:08 am

Warrant number 2070203 702

Amount Payee Account