STAMPED & REDACTED - FOR AGENDA ATTACHMENT - CRUZ TREJO.PDF

v
MAR) COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9* Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

Maricopa.gov

To: Clerk of the Board

From: Office of Budget & Finance, Accounts Payable
Date: 11-18-2024

Subject: Affidavit — Replacement of Lost Warrant

Please find attached one Affidavit for a lost warrant to be included on the next
available Board Agenda.

* The attached item has been researched to ensure the warrant in question has not
been cashed or previously re-issued.

e The original warrant is presumed lost.

Please call Walter Chang at 506-8747 if you have any questions. Please return the
approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor.

Thank you.

Re: Fund: 219 / D190 — County Attorney / vendor name: Cruz Trejo

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

This application is for: Duplicate or C] stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
Cruz Trejo ____.._ (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 10/ 22h 2024 (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 affirrns 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 $600.00 (3)
Signed: te pis — (4)
Print name: (reared) Ceozr Veo) 4c Ae.

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

(5) Subscribed and sworn to before me this_\44 day of Ma ve-en}a'20 D4

Vv. Coes Gar= hee kor

NOTARY PUBLIC

VERONICA RAZO
Net be - State of Arizona

My commission expires:

Warrant/Check Number
Original Date of Issue

ee ttknouns 10/22/2024 sappape
Reason for original issue of Warrant/Check (8): :

UO Payroll

1 For Services or Goods furnished

C1 Treasurer’s refund/payment

@ Other: Victim Compensation Claim 2066323-1 Req 4

S:\PROCESSES\Warrants ~ Duplicate or Stale\02 Forms\Current Claim Form\100518 Watrants Checks notice of claim.doc
Revised 100518 ARS. 11-632 & 11-644

counry exeensewarrant TREASURER OF MARICOPA COUNTY — WARRANT NUMBER

PHOENIX, ARIZONA 3010195882 i
91-2/1221
Six Hundred And 00/100 Doliars
PAY TO THE ORDER OF AMOUNT

Cruz Trejo
Void After
365 Days

For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF FINANCE

NOT NEGOTIABLE

RETAIN THIS FOR | PAYEE WARRANT NO. ; WARRANT DATE | WARRANT AMOUNT

YOUR RECORDS a — ns

ee VICTIM WITNESS 3010195882 10/22/2024 $600.00 ;
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
00000071534K 2066323-1-rqsi4 GAXIF D190 ~~ |5q000009689 600.00/CA

250000009689