STAMPED & REDACTED PHILIP RESNICK .PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: January 7, 2022
To: Clerk of the Board
From: Marcia J. Bulanda

Department of Finance

Subject: Affidavit — PHILLIP RESNICK

Please find attached 1 Affidavit for stale dated 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 is lost.

Please call me at 506-7291 if you have any questions. Please return the approved

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

Thank you.

Re:
FUND 100, D560, PRCPD1-22SNED000421

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

This application is for: Duplicate or (J 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

pade 2 of this form.
PHILLIP RESNICK (1), being first sworn, upon oath deposes and says:
Namé/Craniant

On or about 98-Oct-2021 (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 $3,825.00 -(3)

Signed: Pi22ip Qapwoke Ma D. (4)

Note, Please attach a copy of the watrani/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) Subscribeg'and sworn to before me this _. $/)St day of Donte. 2032 | .

WAL

NOTARY Pyepic

MARK TYLER to
_ . eee: YY PUBLIC - OH
commission expires: wy COMMISSION EXPIRES
5 ee 4 oy 09-01-26 (seal)
4, SH BROS
Warrant/Check Number 4 =
tif known) (6) 301010019

Original Date of Issue

ate of Is 08-Oct-2021 01/07/2022
Reason for original issue of Warrant/Check (8): -

Ci Payroll
(1 For Services or Goods furnished

U Treasurer's refund/payment
Other: / original check presumed lost in the mail

Phillip J. Resnick, M.D.
Professor of Psychiatry

SCHOOL OF MEDICINE ;
CASE WESTERN RESERVE Cleveland, Ohio 44106

UNIVERSITY Phone:

Email:

December 31, 2021

1, Phillip Resnick, am the only employee of my sole proprietor business. I have completed the enclosed
affidavit.

Sincerely yours,

BQoowde, MD.

Phillip Resnick, MD