REDACTED FOR AGENDA ATTACHMENT ARIZONA TITLE AGENCY (1) .PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: August 24, 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 :430 -
Treasurer / Company: First
Arizona Title Agency

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

This application is for: CO 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.

First Arizona Title Agency , LLC (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 30-Sep-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/her in the sum of $425.50 (3)
siqnedr “Ly Wilby) \ ke Va\ SCX (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 w/e this 0] day of agus 20a

My commission expires:

NOTARY PUBLIC Od —S ane aan
issi i ls Notary Public - State i

UNTY :
C1 \\o. Ben t 18 HCPA | (seal)
Warrant/Check Number
ramen 915876
Original Date of Issue
(if known) (7) 30-Sep-2020

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

O1 Payroll
For Services or Goods furnished_/ checks from the Treasurer

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

MARICOPA COUNTY TREASURER 680
ROYCE T. FLORA, COUNTY TREASURER
SERVICING BANK ACCOUNT ~

915876
Vendor ; OneTime0020790, FIRST ARIZONA TITLE, AGENCY LLC
Invoice number Invoice date Description Payment amount
9/30/2020 Refund Reason: Overpayment of\property taxes 425.50
Total 425.50

DETACH AND RETAIN THIS STATEMENT

915876..

4 Acti RIT. s2atoooea

“a DaTeaie! oh oe

EJ. FLORA, BANK ACCOUN

“91-2221 5
September 30 2020 a
Four Hundred Twenty Five Dollars and 50/100 ‘ : $425.50°~ :
‘ CHECK VOID AFTER 365 DAYS i
: 4, (2)

PAYTOTHE FIRST ARIZONA TITLE AGENCY LLC MARIGOPA COUNTY TREASURER

Bed

ORDER OF . tf
yp FILE NUMBER-11-202657 ROYCE T: FLORA, COUNTY TREASURER

AUTHORIZED SIGNATURE

First Arizona Title Agency, LLC

FIRST ARIZONA
TITLE AGENCY eee

August 22, 2022

I, Sandy Saro, authorize Shawna M. Valderrama to execute an affidavit on behalf of First Arizona Title Agency,
LLC

Yours Truly,

Vf
. Sahdy Saro
Branch Manager / Escrow Officer