REDACTED - FOR AGENDA ATTACHMENT - ANDRES MOLINA ISIDOR.PDF
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yy wis g MARICOPA COUNTY Office of Budget & Finance To: Clerk of the Board 301 W. Jefferson St., 9% Floor Phoenix, Arizona 85003 From: Office of Budget & Finance, Accounts Payable Date: 07.02.24 Subject: Affidavit — ANDRES MOLINA ISIDOR P: 602-506-3561 F: 602-506-4451 Please find attached one Affidavit for a stale-dated 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*25963 — D190 COUNTY ATTORNEY - 1894454-1-rqst40 - VICTIM COMPENSATION CHECK Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: a Duplicate or iv] 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 : : page 2 of this form. Andres Molina lsidor (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 26-Jun-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, er 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 g367.27 .(3) Signed: & Auras LOH AF (4) Note: Please attach a copy of the wartant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed wir before me this lo day of May 20 au : NOTARY PUBLIC 4 BLANCA ESTHELA Lo: PE: Notary Pubite - Arizona 7 My commission expires: Maricopa County Commission # 637778 Se~t14. 202 canton ra (seal) Warrant/check Number 199Q003010154049 Original Date of Issue (if known) (7) 26-Jun-2023 Reason for original issue of Warrant/Check (8): OO Payroll Oi For Services or Goods furnished (1 Treasurer’s refund/payment Other: Victim Compensation Check: 1894454-1 - rqst40 COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZONA 3010154049 DATE Three Hundred Sixty Seven And 27/100 Dollars $367.27 PAY TO THE ORDER OF AMOUNT Andres Molina Isidor Void Atter 365 Days For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV NOT NEGOTIABLE MARICOPA COUNTY DEPARTMENT OF FINANCE RETAINTHISFOR|[payrE SS” WARRANT NO. | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS we VICTIM WITNESS _ 3010154049 06/26/2023 $367.27 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT 00000066802K 41894454-1-1qst40 , GAXIFD190.— 230000025983 367.27|CA 230000025963 3010154049 v Werrentnumber esued date Paid date Amveunt ¥ tes Bs Warrant nurse Amount Payee Andres hicding Isider 301018 Account