STAMPED & REDCATED NEIL LABARGE .PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson, 9" Floor
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: August 22, 2022
To: Clerk of the Board
From: Marcia J. Bulanda

Office of Budget and Finance

Subject: Affidavit — NEIL LABARGE

Please find attached 1 Affidavit for a stale-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 lost.

Please call me at 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 222 — D220 HUMAN SERVICES — GAX1D 22*26102
RENTAL ASSISTANCE — JUANITA COLLINS CAS-102703-Q9C6L5 INV-0000524285

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

This application is for: Duplicate or ("I 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

pade 2 of this form.
NEIL LABARGE (1), being first swom, upon oath deposes and says:
Name/Claimant

On or about 14-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 wanin pos year after the date of issuance. 2° Gee zx fe 2,

& i,
proper dy 0s tn Med/iyduch There b neo buss4wess EXFOS
herefore, Under penalty of perjury, claimant hereby affirms that this claim is correc’

and the amount shown is due and owing, and the applicant requests that a replacement

e

warrant/check be j ay Gm of $4,350.00 GB)
a OA
vena LL. : LE. (4)

Co

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

sgribed and sworn to before me this [5 day of une? 20 GA,

NOTARY PUBLIC
My yay, expires: He RICHARDS
MEY ZL b Commie # 62306 (seal)

Expins January 28, 20g8

Warrant/Check Number |
arrant/Check Number 13940419848

Original Date of Issue
GE known) (7) 14-Jun-2022

Reason for original issue of Warrant/Check (8): 08/23/2022
/ 5
C Payroll UaK an / ya /\ K
C1 For Services or Goods furnished J v

{] Treasurer's refund/payment
Other, RENTAL ASSISTANCE - JUANITA COLLINS CAS-102703-Q9C6LS5 INV-0000524285

COUNTY EX.°ENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER

<S, PHOENIX, ARIZONA 3010119848
ie =f DATE
UU) Beetesst Uh 06-14-2022 Preerer
Sap
fe) “

Four Thousand Three Hundred Fifty And 00/100 Dollars

$4,350.00
PAY TO THE ORDER OF
AMOUNT
NEIL LABARGE
Void After
365 Days
Fer Questions - or email NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE,
RETAIN THIS FOR | PAYEE WARRANT NO, | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
NEIL LABARGE 3010119848 06/14/2022 $4,350.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
INV-0000524285 CLIENT: COLLINS, JUANITA- Rental Assistance |GAX1D D220 220000026102 4,350.00

220000026102

Neil Labarge
) 1118 W Greenway Dr
yp) Tempe AZ 85282-6540

iP.
LD USB LLG

RECEIVED BY

AUG 2 0 2022

MARICOPA COUNTY
DOF.