STAMPED & REDACTED ROBERT ABKE.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: October 14, 2022
To: Clerk of the Board
From: Walter Chang

Office of Budget and Finance

Subject: Affidavits - Replacement of Lost Warrants

Please find attached 41 Affidavits for lost warrants to be included on the next available

Board Agenda.
e The attached items have been researched to ensure the warrant in question
have not been cashed or previously re-issued.

e The original warrants have a void/stale date/stop payment done.

Please call me at if you have any questions. Please return the approved
affidavits to my attention in the Office of Budget and Finance.

Thank you.

Re: Fund:675 / Dept: 750 -
Risk Mgmt / Company :
ROBERT ABKE

=

Application for a Duplicate or Stale-Dated mECEIVED

“VED .

=

Affidavit/Claim Form

This application is for: Duplicate or CI sta Afetinitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form MeN spond to
COUNTY OF MARICOPA numbers on the Instruction sheet which is

pane 2 of this form.

ROBERT ABKE (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 13-Sep-2022 (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 $972. 64 .(3)

Signed: __ ; Lick dhe (4)

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

(5) eee to before me this _|[{Vi__day of Oto 20

NOTARY PUBLIC
JAGDHISHKUMAR HEMLAN!
Notary Public - Arizona
Count:
My commission expires: « onanene 9624004
Mey. le ‘fa 2 Oye zt Comm. Expires Mar 18, 2026 (seal)

Wi Check Numbi
ren reoan (8010126903
Original Date of Issue 13-Sep-2022 10/17/2022

Reason for original issue of Warrant/Check (8):

O Payroll
f For Services or Goods furnished / workman comp / WCMAR2004427581 ABKE LEC OCT'22

Treasurer's refund/payment
Other; / check presumed lost / fund : 675 / GAX1D, D750, 23*5634