STAMPED & REDACTED - FOR AGENDA ATTACHMENT - MONTEREY INVESTMENT GROUP.PDF
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v MAR) COPA COUNTY Office of Budget & Finance To: Clerk of the Board 301 W. Jefferson St, 9*Floor From: Office of Budget & Finance, Accounts Payable Phoenix, Arizona 85003 Date: 10-29-2024 Subject: Affidavit — Replacement of Lost Warrant P: 602-506-3561 F: 602-506-4451 Please find attached one Affidavit for a lost warrant to be included on the next Maricopa.gov 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: 296 /D220-Human Resources / vendor name : MONTEREY INVESTMENT GROUP Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or C1 stale-Datea (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. MONTEREY INVESTMENT GROUP (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 11-Sep-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 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 $4,770.40 .(3) Signed: “Ae™~ (4) a i Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. & (5) Subscrib om to before me this <8 _day of_CCuaxPY 2024. KELL! CYNTHIAJOY CAMPBELL Notary Public - State of Arizona i} = MARICOPA Bebb S/ Commission # 624 Expires March 17, 2026 (seal) My commission expires: BlryZip Warrant/Check Number 349199534 (if known) (6) Original Date of Issue (if known) (7) 11-Sep-2024 10/29/24 Reason for original issue of Warrant/Check (8): O Payroll For Services or Goods furnished / TAYLOR, JENNIE - RENTAL ASSISTANCE O Treasurer’s refund/payment Hl Other: / check presumed lost / fund : 296 , initiated by the vendor MONTEREY INVESTMENT GROUP October 28, 2024 |, Ronda L. Walpole, authorize, Tiffany Floyd, Manager, to execute an affidavit on behalf of Monterey Investment Group. Your Truly, Ronda L. Walpole President