REDACTED FOR AGENDA ATTACHMENT ARIZONA TITLE AGENCY (2).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: 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
paade 2 of thisform. =~

First Arizona Title Agency , LLC (1), being first sworn, upon oath deposes and says:
“~WName/Ciaimant

On or about 09-Jun-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 $4, 748.86 -(3)
ret gly Y\ Wate Lu Me (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 swo! before me rome —*\~\__day of ( Luge toh 22>
4

NOTARY PUBLIC (/(_7

nar OFFICIAL SEAL 1
My commission expires: re oo! ( SARO |
GMb “a i es MARICOPACOUNTY ; (seal)
Comm. #548583 Exp. Sept 16, 2022 f
Warrant/Check Number |gnga7zz7 2”
(if known) (6) 909377,
Original Date of Issue
8 (if known) (7) 09-Jun-2020

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

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

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

MARICOPA COUNTY TREASURER fl

ROYCE T. FLORA, COUNTY TREASURER
SERVICING BANK ACCOUNT

909377
Vendor : OneTime0016977, FIRST ARIZONA. TITLE AGENCY, LLC
Invoice number Invoice date Descniption Payment amount
6/9/2020 PARCEL# 168-75-026/4C 4,748.86
Total ‘ i 4,748.86

DETACH AND RETAIN THIS STATEMENT

BL ALORA, BANK: ACCOUNT :

June 09 2020_
$4,748.86

CHECK VOID AFTER 365 DAYS.

Four Thousand Seven Hundred Forty Eight Dollars and fenoo

ED  petaits on Bac

Pa TOTS FERS RRTAONR TEELE AGENEE, LABEL. MARIGOPA-COUNTY TREASURER
/ ROYCE T. FLORA, COUNTY TREASURER

flog J. $lor

AUTHORIZED SIGNATURE

i

_Security Features included.

:
|
i
i
i

First Arizona Title Agency, LLC

FIRST ARIZONA ;
TITLE AGENCY Seah

August 22, 2022

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

Yours Truly,

“ba iy Saro
Branch Manager / Escrow Officer