STAMPED & REDACTED - FOR AGENDA ATTACHMENT - AZ CRIMINAL JUSTICE COMMISION.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: 11/19/2024

Subject: Affidavit — Replacement of lost warrants

Please find attached 1 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 and is stale dated.

Please call Joyce Maurmann at 506-1343 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: Warrant #3010191389 / AZ CRIMINAL JUSTICE COMMISSION
Fund 219 — D190 GAX1D 250000003538

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

This application is for: fal Duplicate or C) stale-pated (definitions. are on page 2)

STATE OF ARIZONA Nate: Numbers on this form correspond to numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
AZ CRIMINAL JUSTICE COMMISION (1), being first sworn, upon oath deposes and says:
Name/Claimant .
On or about 08/28/2024 (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 inadvettently lost or destroyed and’ there is
no reasonable probability of its being found or presented for payment, gr 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

voronc f “fe to him/her in the sum of ¢2384.28 (3)
Signed: 4 UM (4)

Print name: (pe ») ASO Grou 2

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 \ day of Otley 20Z4/-,

Koo Winer Arar
NOTARY PUBLIC

~My commission expires:

Deceniber by Poesy (seal)

Warrant/Check Number
Original Date of Issue
Cif knowin) (oo (08/ 28/ 20 24 _ or
Reason for original issue: of Warrant/Check: (8): i
CO Payroll

{1 For Services or Goods furnished

i Treasurer's refund/payment
J Other, VC1827443-1R, VC1823694-1R

S:\PROCESSES\Warranits « Duplicate or Stale\O2 Forms\Current Claim Form\100818 Warrants Checks natice of claini.doc
Revised 100518 ARS, 11-632 & 11-644

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ite a
Mun 2

Chaiperson

DAVID BYERS

Director, Administrative Office of
the Courts

Vice-Chairperson
STEVE STAHL
Law Enforcement Leader

JEAN BISHOP
Mohave County Supervisor

MICHELLE BURNS
Former Judge

BRAD-CARLYON
Navajo County Attorney

LAURA CONOVER,
Pima County Attorney

JEFFREY GLOVER
City of Tempe, Chief of Police

KRIS MAYES
‘Arizona Attorney General

MINA MENDEZ
Board of Executive Clemency

RACHEL MITCHELL,
Maricopa County Attorney

CHRIS NANOS

Arizona Criminal Justice Commission

Maricopa County Attorney's Office
225 W. Madison St.
Phoenix, AZ 85003

10-31-24
To whom it may:concern,

I, Lisa. Kautz, authorize Jason Enlow, Accountant I, to execute and sign for an affidavit for
the Arizona Criminal Justice Commission.

Thank you,

Date

-

ACSC Finaficé Mariager

a

Pima County Sieritt

PAUL PENZONE
Maricopa County Sheriff

KARA RILEY
Oro Valley, Chief of Police

DAVID SANDERS.
Pima. County Chief Probation
Officer

LANCE SPIVEY
Police Chief, St: Johris

RYAN THORNELL
Director, Arizona Department of
Corrections

Executive Director
Andrew T. LeFevre

1410 West Washington, Suite 230

Phoenix, Arizona 85007
PHONE: (602) 364-1146
FAX(602) 364-1175

WWW.AZCIC.00V

Our ntission is to continuously address, improve, sustain and enhance public safety in the State of Arisana through

the coordination, cohesiveness, and effectiveness of the Criminal Justice Systent

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010191389

DATE
08-28-2024 91-2/1221

Two Thousand Three Hundred Eighty Four And 28/100 Doflars

$2,384.28
PAY TO THE ORDER OF AMOUNT
AZ CRIMINAL JUSTICE COMMISSION
Void After
365 Days
For Questions - 602-806-1379 or email AP@MAIL.MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NG. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
AZ CRIMINAL JUSTICE COMMISSION 3010191389 08/28/2024 $2,384.28
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
VC1827443-1R FY25 DUPLICATE MEDICAL EXPENSE REIMBU |GAX1D D190 250000003538 2,104.63
250000003538
41813 FY21
VC1823694-1R FY25 REIMB MENTAL HEALTH OVERAGE VC1E&{GAX1D D190 250000003538 279.65

250000003538