REDACTED - FOR AGENDA ATTACHMENT - YUREDI DIAZ.PDF
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eI. & iO 2 MAR) COUNTY ye Office of Budget & Finance 301 W. Jefferson St., 9% Floor Phoenix, Arizona 85003 P: 602-506-3561 F: 602-506-4451 Maricopa.gov COPA To: From: Date: Clerk of the Board Office of Budget & Finance, Accounts Payable 07.11.24 Subject: Affidavit — YUREDI DIAZ Please find attached one Affidavit for a stale-dated 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 — GAXIF 23*22971 — D190 COUNTY ATTORNEY— MVICTIM - 1970507-1- rqst7 Application fora Duplicate or Stale-Dated Warrant/ Check ° ¢ Affidavit/Claim Form This application is for: C] ‘Duplicate or Stale-Dated (definitions are on page 2) STATE OF ARIZONA : . Note: Numbers on this form correspond to COUNTY OF T\-\RICOPA numbers on the Instruction sheet which is : a's paae 2 of this form. Yuredi A Diaz _(1), being first sworn, upon oath deposes and says: Name/Claimant On or about 17-May-2023 | (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 ¢84. 88 (3) Signed: Br (4) Note: Sease attach a copy of ihe warratit/check if available ana/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this _Z é day of Alar ch 20 2¥ OS Le NOTARY PUBLIC RUSSELL GAVIDIA Notary Public - State of Michigan ie commis fon expires: County of Wayne ZZ. 7 a O48 My Commission Expires Apr Be 2028 (seal) Acting in the County of & Warrant/Check Number CF known} (6) 301 0 1 50804 Original Date of Issue _ 9 (if known) (7) 1 ¢-May-2023 Reason for original issue of Warrant/Check (8): C] Payroll C) For Services or Goods furnished C] Treasurer's refund/payment =) Other: Never received check for Request #5 county expense warrant = TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZONA 3010150804 DATE 05-17-2023 91-211224 Eighty Four And 88/100 Dollars $84.88 PAY TO THE ORDER OF AMOUNT Yuredi Diaz Void After 385 Days For Questions « 602-406-1379 or email AP(@MATL MARICOPA,.GOV NOT NEGOTIABLE MARICOPA COUNTY DEPARTMENT OF FINANCE RETAIN THES FOR | PAYEL, WARRANT NO, | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS —— VICTIM WIT ee 3010TS0804 05/17/2023 $84.88 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT 00000066807K 1970507--rgs GAXIF D190 230000022971 B4.88ICA 230060022971 < YF DE - (7 Agency Status Warrant number — istued date Paid date Amount en, + FONOSOE ow . + ¥ Warrant number: Amount © Payee Agcount 2462 Yuredi Giar