VICTIM MELISSA CALDERA AFFIDAVIT.PDF

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

This application is for: O Duplicate or 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
. paae 2 of this form.
Melissa Caldera (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 03-Feb-2020 (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, pres in the sum of $600.00 .(3)

Signed: Mirrm Lh (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_“S day of Kugus% 20%2.

aie Dhan

NOTARY PUBLIC

SANDRA MCKEOWN
Netaty Public Arizona

icc irec: Mariéepa County
My commission expires: Pm pe AR

| Saaele Ae _ | mimi fo) |
Warrant/Check Number 1304 0055145,3010052781&3010053220

Original Date of Issue
(if known) (7)

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

OO Payroll
OO For Services or Goods furnished

O) Treasurer’s refund/payment

Other: CR2019-116855-001

)EGCEIVEN|
il aug 22 2022 |)

reer oS

SS. TREASURER OF MARICOPA COUNTY WARRANT NUMBER
sé PHOENIX, ARIZONA 3010053220

DATE
02-11-2020 91-2/1221
Fifty And 00/100 Dollars
50.00
PAY TO THE ORDER OF kai 5
MELISSA CALDERA AMOUNT
Void After CHAIRMAN :
ok 365 Days 45 ) ;
1o CLERK OF THE BOAR® E
——e ‘
For Question or email : NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
VICTIM WITNESS 3010053220 02/11/2020 $50.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
CR2019-116855-001-| FPIP-NATISSA MANNS GAX1D D190 200000026250 50.00] CA
200000026250

THIS DOCUMENT CONTAINS A TRUE WATERMARK - HOLD TO LIGHT TO VIEW

TREASURER OF MARICOPA COUNTY

WARRANT NUMBER

CA

PHOENIX, ARIZONA 3010052781
DATE
i NE 91-2/1221
Three Hundred Fifty And 00/100 Dollars
TO THE ORDER OF $350.00
PAY ER
AMOUN
MELISSA CALDERA u
CW.
Void After CHAIRMAN
YN 365 Days
y CLERK OF THE BOARD
For Questions - or emai’ NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
VICTIM WITNESS 3010052781 02/03/2020 $350.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
CR2019-116855-001-| FPIP-NATISSA MANNS GAX1D D190 200000025172 350.00

200000025172

Security Features included. [ED  petaits on Back. .

THIS DOCUMENT CONTAINS A TRUE WATERMARK - HOLD TO LIGHT TO VIEW

“TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

COUNTY EXPENSE WARRANT

Two Hundred And 00/100 Dollars

~ WARRANT NUMBER
3010055145

91-2/1221

$200.00

PAY TO THE ORDER OF

AMOUNT

MELISSA CALDERA

wo
2
Ss

é

C4

CHAIRMAN

a OF THE BOARD

ED Detaits on Back. _{<s

Security Features Included.

For Questions - or email NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS

VICTIM WITNESS 3010055145 03/13/2020 $200.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
CR2019-116885-001-| FPIP-NATISSA MANNS GAX1D D190 200000029662 200.00

200000029662

CA