STAMPED & REDACTED SOUTHWEST GAS (1).PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: April 25, 2022
To: Clerk of the Board
From: Joyce Maurmann

Department of Finance

Subject: Affidavit - Replacement of stale dated Warrant

Please find attached 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 warrant was lost and not received by vendor

Please call me at . if you have any questions. Please return the approved
Affidavits to my attention in the Department of Finance, Suite 960.

Thank you.

Re: Southwest Gas Inc
D220 GAX1D 22*6256 FUND 222

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for:

Duplicate or Cc Stale-Dated (definitions are on page 2)

STATE OF ARIZONA
COUNTY OF MARICOPA

pade 2 of this form.

Note: Numbers on this form correspond to
numbers on the Instruction sheet which is

SOUTHWEST GAS INC

Name/Claimant
On or about 07-Oct-2021
above named person/entity in the amount as stated below.

(1), being first sworn, upon oath deposes and says:

(date)(2) a warrant/check was issued to the
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

(3)

i the sum of $1,997.30
aay,

(4)

e: Note: Pied “attadl’s copy of the warrant/check if available and/or any other

evidence that a warrant/check was originally issued.

) Subscribed and sworn to before me this_/37% _day of Lon / 20_#2,.
Wyte i Mase Lh, a
C —NOTARY PUBLIC
>, DIANALOUISE TAFOYA 1. |
My commission expires: 5 jp COMM. #2528583 3
Warrant/Check Number
‘it known) (6) 3010099937
Original Date of Issue
eee 07-Oct-2021
04/26/2022
Reason for original issue of Warrant/Check (8): -
1 Payroll
For Services or Goods furnished UTILITIES
1 Treasurer's refund/payment
Other: ORIGINAL CHECK PRESUMED LOST

$e SOUTHWEST GAS CORPORATION

April 15", 2022

To Whom It May Concern,

|, Kim Miller, authorize Kelly Casillas, Supervisor, to execute an affidavit on behalf of
Southwest Gas Corporation.

Thank you,

AIR Ae

Manager
Southwest Gas