STAMPED & REDACTED - FOR AGENDA ATTACHMENT - DAVID HARDESTY.PDF

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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: 08.22.24

Subject: Affidavit — DAVID HARDESTY

Please find attached-one Affidavit for a duplicate lost/stolen 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.

2 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 ihe Office of Budget and Finance, 9" Floor.

Thank you.

Re: FUND 100- D520 PUBLIC DEFENDER - GAX1D 24*19400 — PD2016-60089

Application for a Duplicate or Stale-Dated Warra nt/ Check
Affidavit/ Claim Form ie

This application is for: fa Duplicate or CL] Stale-Dated (definitions are on Page 2)

STATE OF ARIZONA: Note: Numbers on this form correspond fo numbers on the
COUNTY OF MARICOPA Instruction sheet which is page 2 of this form.
DAVID HARDESTY

Namre/CIanart (1), being first swom, upon oath deposes and says!

On or about 09-05-2024 (Jate)(2) a warrant/check was issued to the

above named person/entity in the amount as stated below. Such warrant/check was i
either never received or was subsequently inadvertently lost or destroyed and there is |
no reasonable probability of its being found or presented for payment, of it was not i
‘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 shawn is due and owing, and the applicant requests that a replacernent

¢ fg

(3)

warrant/check

Signed:

|

et (4) }

Note: Please attach a copy of the warrant/check if avajlable and/or any other |
i

evidence that 2 warrant/check was originally issued.

(5) cribed and\swom to before me this [Cp day of A UA 20 24.
iawn -
y

NOTARY PUBLIG4 = LT :

Heidi Ashty

: . samme Notary Public
ia MMission expires: es) Yavapai aunty; Arizona
Oke eae mci? My Comm. Expires 02-09-28 (eal)

Cormnission No. 682998

Warrant/Check Number :
{if known) (6) 3010181694
Original Date of Issue OG.
(if krown) (7) 09-05-2024
Reason for original issue of Warrant/Check (8): i _ 8/23/24
Payroll

O) For Services or Goads fumished

O Treasurer's refund/payment
OC Other: FUND 100 - D520 PUBLIC DEFENDER - GAX1D 24*19400 - PD 2016-60089

: . i ks notice of aim - Copy.doc
meme Duplicate or Stale\O2 Forms\warrants Checks noi py. ARS 108008 11.646

CO! TY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER

PHOENIX, ARIZONA 3010181694
DATE

Two Hundred Twenty Five And 95/100 Doilars

$225.95

PAY TO THE ORDER OF
David Hardesty AMOUNT

Void After
365 Days.

For Questions - 602-506-1379 or email AP@MAIL MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE.

RETAIN THIS FOR | PAYEE, WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

YOUR RECORDS
___ [MISCELLANEOUS VENDOR 3010181694 osvo92024 |
NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
0582024  ~——«( PD 2016-60089 GAX1D D520 240000019400 ~ -225.95|PU

240000019400

LL] Agency Status Warrantnumber Issued date Paid date Amount

+ peeved, Join e194

Warrant number: |

Amount Payee Account

David Hardesty