STAMPED & REDACTED - FOR AGENDA ATTACHMENT - BAYRON GALASSI-ALVARADO.PDF

MARICOPA
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: 10.22.24

Subject: Affidavit — BAYRON GALASSI-ALVARADO

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

e 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 Marcia Bulanda at 506-7291 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 — GAXIF 25*5247 - MVICTIM INTERFACE —
VICTIM COMPENSATION CLAIM: 1972579-1 REQ 4&5

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.

Bayron Galassi- Alvarado (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 08/29/2024 (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 pe in the sum of ¢1 951 .60 -(3)
Signed: , 4)

Ga

(
Print name: (required) Bay e6C\ bo la S>| A Voy cdo

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

“m Subscribed and sworn to before me this _{@ day of dclole “2024.

NOTARY PUBLIC

mye commission pores: Wes ;
alisha _ (seal)

W. t/Check Numb
arrant/Check Number 13040191466

Original Date of Issue
10/22/24
Reason for original issue of Warrant/Check (8): -
[1 Payroll
C) For Services or Goods furnished

oO Treasurer's refund/payment

@ Other: Victim Compensation Claim: 1972579-1 Req 4&5

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

COUNTY Expense warrant TREASURER OF MARICOPA COUNTY — WARRANT NUMBER
PHOENIX, ARIZONA 3010191466

¥
marae“)
) Per | (| 91-2/1221
@ a
One Thousand Nine Hundred Fifty One And 60/100 Dollars
$1,951.60
PAY TO THE ORDER OF rey cre oe
U
Bayron Galassi-Alvarado AMOUNT
Vold Afler
365 Days
NOT NEGOTIABLE

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

WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

RETAIN THIS FOR | PAYER

YOUR RECORDS a - a
[VICTIM WITNESS 3010191466, 08/29/2024 | $1,951.60
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
o0o00071068K ——~|1972579-t-rqsi4 GAXIF D190 250000005247 1,492.40|CA
250000005247
00000071066K 4972579-1-rqst5 GAXIF D190 250000005247 459.20.CA

250000005247