STAMPED & REDACTED TELEDYNE FLIR DETECTION INC .PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: September 21, 2022
To: Clerk of the Board
From: Walter Chang

Office of Budget and Finance

Subject: Affidavits — Replacement of Lost Warrants

Please find attached 1 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: 100 / Dept: 500/
MSCO/ Company:
Teledyne FLIR Detection Inc

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

This application is for: Duplicate or J state-pated (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.

Teledyne FLIR Detection Inc (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 17-Jun-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 wh of $i ,838.00 -(3)

oo f
Signed: tae LL Pa 2 Ke LL (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) Subscribed and sworn to before me this LY day of Avant 20 fA_.
ell
bec

+t
NOTARY PUBLIC I Commonwealth of Pennsylvania - Notary Seal
Jeffrey T. Stlehler, Notary Public

Allegheny County
4 commission expires: My commission expires July 16, 2026
7 Commission number
\y 4 doar Member, Pennsytvania Association ef Nctaries

(seal)

Warrant/Check Number | 3940420185

(if known) (6)

Original Date of Issue
(if known) (7) 17-Ju n-2022

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

1 Payroll

For Services or Goods furnished / Surveillance Cameras and Counter-surveillance Equipment

C1 Treasurer's refund/payment
Other: / check presumed lost / fund : 100

09/21/2022

/

<A UGK at / a

9/14/2022

1, Thomas Blair, authorize Theresa Ballard, Administrator, to execute an affidavit on behalf
of FLIR Detection.

Tea,

re eat) Credit and Collections

2240 William Pitt Way, Pittsburgh PA 15238 (412}423-2100
www. ilircom