STAMPED & REDACTED - FOR AGENDA ATTACHMENT - DELTA ASSOCIATED INVESTIGATIONS INC.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: 9/20/2024

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 #3010187654 /DELTA ASSOCIATED INVESTIGATIONS INC
Fund 675 — D750 GAX1D 250000000777, and GAX1D 250000000507

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/ Claim Form

This application is for: Duplicate or Cl stale-Dated (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

paqe 2 of this form.
DELTA ASSOCIATED INVESTIGATIONS INC (4) being first sworn, upon oath deposes and says:
Name/Claimant

On or about 16-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

warrant/check be issued to him/her in the sum of §. 3,595.00 (3)

Signed: Re wis Chngeten (4)

Note. Yease’sttach @ copy of the watrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) Subscribed and sworn to before me this __i} day of Sepia nea 20.244 .
how. [bre allprer inning,

NOTARY PUBLIC

My commission expires:

(~?-2a7

W. Check Numb
arrant heck o- er 13010187654

Original Date of Issue
(rinsed Os 16-Jul-2024

Reason for original issue of Warrant/Check (8):

L) Payroll .
OO For Services or Goods furnished

9/20/24

1 Treasurer’s refund/payment
© Other; Risk Management - Workers Comp

September 11, 2024

Maricopa County Office of Budget and Finance
Attn: Joyce Maurmann

301 W. Jefferson St, 9" Floor

Phoenix, AZ 85003

RE: Check Number 301087654
Claim Number WC116023017567
To Whom It May Concern:

I, Nancy Gillis, authorize Jennifer Canger, Accounts Receivable Manager, to execute an
affidavit on behalf of Delta Group

Sincerely,

“Teves J il

Nancy Gillis
President

Enclosed: Application for a Duplicate Check Affidavit