STAMPED & REDACTED DIONNE DEWITT.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: April 26, 2022
To: Clerk of the Board
From: Nadine Higuera

Department of Finance

Subject: Affidavit — Replacement of lost warrant

Please find attached 1 Affidavit for a lost warrant 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 warrant was lost and not received by vendor

Please call me at 506-1354 if you have any questions. Please return the approved

Affidavits to my attention in the Department of Finance, Suite 960.

Thank you.

Re: DIONNE DEWITT
D750 GAX1D 22*18682 FUND 675

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form ‘rt 4

This application is for: ial Duplicate or CI 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.
DIONNE DEWITT (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 16-Mar-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, ar 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 fim/her in the sum of 4370.00 3)
A ‘ _—
Signed: Ati - BrwlN (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) sai and sworn to before me this [% day of A. pr l 20 22-

NOTARY POBLIC ee
rent, NOTARY PUBLIC ARIZONA
My commplssien sxpites: commiston #659086
Ce]O4] 2077 wveenmecenereres bead
Warrant/Check Number
(it known) (6) 3010112311
Original Date of Issue
(if known) (7) 1 66-Mar-2022
Reason for original issue of Warrant/Check (8):
C1 Payroll
04/26/2022

For Services or Goods furnished

O Treasurer's refund/payment
0 Other: Presumed fost

Fund 675 Dept 750 GAX1D 22*18682

Nadine Higuera (FIN)

LEESLE
From: Tracey Wright (RMD)
Sent: Tuesday, April 12, 2022 2:54 PM
To: FIN AccountsPayable
Subject: Lost Check - 3010112311 for Dionne Dewitt
Hello all,

Can you please start the lost check process for check number 3010112311 for Dionne Dewitt? You can send the affidavit
and instructions to Ms. Dewitt at

_ Disbursement Document “Vendor Code Vendor Name ‘Payee Name Traveler ib Check Amount Issued Date ‘CheckiEF

¥ D.0180.220000020113.1 _ MSETTLE . DIONNE DEWITT. DIONNE DEWITT tady pa tler 5370, 00 03/16/2022 00000301¢
First Prev Next Last

Record Date: 9316022 Total Discount Amount: 0 6G
Disbursement Doc Type: an Total Penalty Amount: $0.00
Disbursement Doc Code: ap. Total interest Amount: $9 po
Disbursement Doc Dept: pisp Total Backup Withholding Amount: $9.00
Disbursement Doc ID : 229900920113 Total Contract Withholding Amount: $9.96
Payee Code: Total default Intercept Fee Amount: 39.09
Payee Name: DIONNE DEWITT Total Supplementary Intercept Fee Amount: 26 00
Payee Indicator: y ‘ Total Retainage Amount: £9 00
Total-Accounting Line Amount :.£370.00 Total Freight Amount: 5¢.00
Total Intercept Amount: sp.90 Total Use Amount: 89.06
Issued Date : 93/1672022 ‘ Total Tax Amount: 29.96
Check/EFT Number : og0003040112344 Cancel/Reclass Reason:
Check Status i Disbursed iv] : G2 lltbe lb acopenl eri _ Nendor Code : MSETTLE
\ Cleared Date: Sa EH ieieen Mendor Name’: DIONNE DEWITT
Check Amount: $370.06 i é Traveler ID:
: : Disbursement Category Hi

Tracey Wright, Accountant
Maricopa County Risk Management

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COUNTY EXPENSE WARRANT

( Bes

ay
Three Hu

PAY

ndred Seventy And 00/100 Dollars

TO THE ORDER OF

DIONNE DEWITT

TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

DATE
03-16-2022

Void After
365 Days

WARRANT NUMBER
3010112311

91-2/12214

$370,00

AMOUNT

For Questions - or email NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
SETTLE 3010112311 03/16/2022 $370.00

INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT

422BEWt WEMAR2012709704 DEWH FLEE APR 2: GAX1D-B750 220000048682 370-88}PV
220000018682