STAMPED & REDACTED - FOR AGENDA ATTACHMENT - GLADIS RAMIREZ FABIAN.PDF
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i MAR COPA | COUNTY | . Office of Budget & Finance To: Clerk of the Board 301 W. Jefferson St, 9" Floor From: — Office of Budget & Finance, Accounts Payable ' Phoenix, Arizona 85003 H Date: 07.02.24 Subject: Affidavit — GLADIS RAMIREZ FABIAN P: 602-506-3561 F: 602-506-4451 Please find attached one Affidavit for a lost warrant to be included on the next Maricopa.gov 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 24*21401 —- D190 COUNTY ATTORNEY - 2014675-1-rqst6 — VICTIM COMPENSATION CHECK Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/ Claim Form This application is for: Duplicate or CJ state-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 paae 2 of this form. Ramirez Fabian, Gladis _ (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 28-Mar-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, ar 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 $ 130.38 .(3) Signed: % & (4) Note: Afease attach a copy of the wartant/check if available and/or any other evidence that a wattant/check was originally issued. (5) Subscribed and sworn to before me this “2© day of__ Juana 2024). NOTARY PUBLIC aOR “ IMANE MONAE POMPEY Notary Public, State of Arizona Maricopa County issi i o ission € 642314 My a ena Va ee ater Mav Commission Expires an ' t aaa Sab danuary tt, 2027 at} (cea Warranticheck Number 1900003010177846 | Reason for original issue of Warrant/Check (8): 7/8/24 (Payroll (1 For Services or Goods furnished C1 Treasurer's refund/payment Other: Victim Compensation Check: 2014675-1-rqst6 county exeensewarnarr —- TREASURER OF MARICOPA COUNTY PHOENIX, ARIZONA Ar pion “ (| oun’ One Hundred Thirty And 38/400 Dollars PAY TO THE ORDER OF Giadis Ramirez Fabian For Questions - 602-506-1379 or email AP@MAH.MARICOPA.GOV MARICOPA COUNTY DEPARTMENT OF FINANCE WARRANT NUMBER 3010177846 DATE $130. AMOUNT Void After 365 Days NOT NEGOTIABLE RETAIN THIS FOR PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS VICTIM WITNESS 3010177846 03/28/2024 $130.38 INVOLCE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT GAXIF 0190 240000021401 | 130.38 O0000069646K 2014675-1-rgst6 240000021401 CA Wanant number — Issued date = 30101 Warrant nursber: 7 Amount Payee Glacis Hannes Fablan Account Paid date Araeunt ¥