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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: November 23, 2021 To: Clerk of the Board From: Maria Meza Department of Finance/Accounts Payable Subject: Affidavit: TREASURER REFUND- SCH VENTURES LLC Ckwee4215 1019 $2066.00 Please find the attached Affidavit for a stale dated Treasurer Refund 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 is lost. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960 or email to MARIA.MEZA@MARICOPA.GOV. | may be reached at 602-506-1379 if you have any questions. Thank you. Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit /Claim Form This application is for: oO 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 page 2 of this form. (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 02-Jan-2019 _ (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 $2,066.08 (3) Signed: Cathyuine LH W4Wt4_ (4) CS 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 sworn to before me this 4 day of Nottember 20 a . NOTARY PUBLIC Commonwealth of Pennsylvania - Notary Seal at . JASMEN GIBSON, Notary Public My commission expires: ¢ Philadelphia old 40003 My Commission Expires October 4, lO] Ot] WL . Commission Number 1358474 (seal) Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll C1 For Services or Goods furnished Treasurer's refund/payment PARCEL# 504-27-123 & 504-27-126 O Other: