STAMPED & REDACTED-KIMBERLY GOON.PDF

ee

MARICOPA
COUNTY

SRN

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: 04/29/25

Subject: Affidavit — KIMBERLY GOON

Please find attached one Affidavit for a Duplicate payment 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: Lost Warrant - Fund 100- D800 SUPERIOR COURT - GAX1D 25*15763 — FY25 STGJ
MEALS — JURY MEAL PAYMENT

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Ciaim Form

This application is for: Duplicate or C 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.
Kimberly Goon (1), being first sworn, upon oath deposes and says:
Name/Claimant ,
On or about 8~- April 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 amount shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $ 58:00 3)

signed Sn ain 2 ton Voy Digan (4)
a OO
Print name: (required) Ki aa logy lp (3,004)

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

(5) Subscribed and sworn to before me this _L-4 day of h pri 20.25.
wo ™N,
NOTARY PUBLIC COBY WRIGHT
Béotary Pubtlo - State of Arizona
My commission expires: Eominiasen F208 7
May _igrh Lele Expires May 14,2028 (seal)
1
Warrant/Check Number
(if knowin) (6) 3010209399
Original Date of Issue ‘
(i known) (7) 8 - April 2025
Reason for origirial issue of Warrant/Check (8): 4/29/25

(1 Payroll :
C1. For Services: or Goods furnished
1 Treasurer's refund/payment

fl Other; Jury Meal Payment

S:\PROCESSES\Warranis - Duplicate or Stale\02 Forms\Current Claim:Form\100518 Warrants Checks notice of claim.doc
Revised 100518 ARS, 11-632 & 11-644

(] Agency Status Warrant number . {ssued date Paid date Amount
~ Issued | zoroz0s399 ~ . -
2000 Issued 3010209399 4/8/2025 12:00:00 am __ 58,00!

Warrant number: 307020

Amount . Payee

FIMBERLY GOOMH

Account

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER

PHOENIX, ARIZONA 3010209399
DATE
Fifty Eight And 00/100 Dollars
$58.00
PAY TO THE ORDER OF
AMOUNT

KIMBERLY GOON

Void After

365 Days

For Questions - 602-506-1379 or email ARP@MAIL.MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
JURY COMMISSION 3010209399 04/08/2025 $58.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
KG0331/2025 FY25 STGJ MEALS _K.GOON 3/31/25 GAX1D D800 250000015763 98.00

250000015763