STAMPED & REDACTED - FOR AGENDA ATTACHEMENT - DONNA TEUTSCHEL.PDF

MAR)COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9 Floor
Phoenix, Arizona 85003

To: Clerk of the Board
From: Office of Budget & Finance, Accounts Payable

. Date: 10.02.24

P: 602-506-3561
F: 602-506-4451

Maricopa.gov

Subject: Affidavit - DONNA TEUTSCHEL

Please find attached one Affidavit for a duplicate 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.

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*2168—VICTIM COMPENSATION
PROGRAM; 2059077 — 1 REQUEST 2

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Ciaim Form

This application is for: = Duplicate or [J 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.

DONNA TEUTSCHEL (i), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 07/25/2024 (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 Issuedto him/her, in the sum of ¢ 1 780.06 .G)

| L. /
Lp whaedef (4)

Print name: (required) Downs IeuTe/ HEL.

i

Signed: 0/443

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

ik and sworn to before me this__2$ day of _Quyust 20.244.

NOTARY PUBLIC

My commission expires: a
! Ole- Zhe - 2025" me (seal)
Warrant/Check Number
‘tknoun) (6) 8010188338
Original Date of Issue
(ranean) Op 07/25/2024 10/03/24

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

1 For Services or Goods furnished

1 Treasurer’s refund/payment
Other, VICTIM COMPENSATION PROGRAM; 2059077-1 REQUEST 2

S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\i00518 Warrants Checks notice of claim.doc
Revised 100518 ARS, 11-632 & 11-644

ACKNOWLEDGMENT

A notary public or other officer compieting this |
certificate verifies only the identity of the individual

who signed the document to which this certificate is |
attached, and not the truthfulness, accuracy, or
validity of that document. _ 5

State of California

County of _ Catt. Cagka )

on Bi 2e\ zo2y before mXRODAED eolingky pot Nat Detaic.

(insert name and title of the officer)

personally appeared \t Dahon ~~ euts chef ;
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

| certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.

ROBERT 8. STOLINSKI

WITNESS my hand and official seal. Notary Public - California
Contra Costacounty

Bee Commission #2359525
C) . SO” ny Comm, Expires Jun 26, 2025
Signature Ay t J rbugl. Seal
gALiAtt

county exeense warrant TREASURER OF MARICOPA COUNTY — WARRANT NUMBER
: 3010188338

PHOENIX, ARIZONA

DATE

One Thousand Seven Hundred Eighty And 06/100 Dollars

$1,780.06
AMOUNT

PAY TO THE ORDER OF

Donna Teutschel
Void After
365 Days

For Questions - 602-506-1379 or email AP@MAIL. MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF PINANCE

NOT NEGOTIABLE

WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

RETAIN THIS FOR | PAYER
YOUR RECORDS
VICTIM WITNESS 3010188338 07/25/2024 $1,780.06
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
GAXIF D190 250000002168 1,780.06)CA

00000070746K 2059077-1-rqst2
250000002168

| “issued warrants (Unsaved fitten ~

LD Agency — Status Warrant number — Issued date

ds. i
‘,

[jo1o1gagza « © -

i
il ~é Issu

i! _3ON0188332 | 725 /2024

Aga ag3ag

yb + 1
vlarrantrnriver: sto ees se

Amount Payee Account

1,720.06 Denne Teutechel | |