STAMPED & REDACTED - FOR AGENDA ATTACHMENT - PHOENIX HERPETOLOGICAL SOCIETY.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: 09.12.24

Subject: Affidavit — PHOENIX HERPETOLOGICAL SOCIETY

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 244 —- D650 LIBRARY DISTRICT — GAX1D 25*00024-PERFORMERS CHECK —
DESERT REPTILES, 3 PERFORMANCES FOR SR24

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

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

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA numbers of tne Instruction sheet which is

PHOENIX HERPETOLOGICAL SOCIETY (1) being first sworn, upon oath deposes and says:
Name/Claimant

On or about 92-Jul-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

Signed: _\y A bei. (4)

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

eh issued to him/her in the sum of $865.00

(5) Subscribed and sworn to before me this f ___day of Sephember 20 of 4

NOTA
My commission expires:

{seal}
Warrant/Check Number j
(if known) (6) 30 1 01 8661 4 —
Original Date of Issue
(if known) (7) 02-Jul-2024 7 |
Reason for original issue of Warrant/Check (8): 9/17/24

OO Payroll

0 For Services or Goods furnished

O) Treasurer's refund/payment

. Fund 0244-LIBRARY DISTRICT - GAX1D 25°00624 - PERFORMERS CHECK « QDESERT # LES, Ri Ee
Oth er: K REPT 3 PERFORMANC!

Phoenix Herpetological Sanctuar

“Caierseo Aci Fe Die Teel

9/11/2024

|, Debbie Gibson, authorize Isabel Kostich, Education Administrator, to execute an
affidavit on behalf of the Phoenix Herpetological Sanctuary

Yours truly,

Debbie Gibson, V.P

“Conservation Begins With Education”

PhoenixHerp.com

COUNTY EXPENSE WARRANT

Eight Hundred Sixty Five And 00/100 Dollars

PAY TO THE ORDER OF

For Questions - 602-506-1379 or emsil AP(@MALL. MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF FINANCE

RE'CALN THIS FOR
YOUR RECORDS

PAYEE

TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

Void After
365 Days

WARRANT NUMBER

3010186614

91-2/1224

$865.00

WARR AN r N i y ]

WARRANT DATE

AMOUNT _

NOT NEGOTIABLE

WARRANT AMOUNT

tT
'
}
| 3010186614
P

PHOENIX HERPETOLOGICAL SOCIETY 07/02/2024 $865.00
INVOICE NUMBER | DESCRIPTYON URCHASE ORDER NO. | VOUCHER NO. AMOUNT
23-0572 Performers check: Desert Reptiles, 3 performance |GAX1D D&50 250000000024 865.00

250000000024

List

“| "# Isgued warrants (Unsayed fiteri ~ | c fier
p Pony Warrant number Issued date Paid date Ameunt
. f Issued \ i 3010186614 . L . . .

Warrant number: 308014

Amount Payee Account

i! 265.00 PHOENIX HERPETOLOGICAL SOCIETY P|