REDACTED - FOR AGENDA ATTACHMENT - ANTONIA CORTEZ ESPIRITU.PDF

MARICOPA
COUNTY

Pons
i

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

Date: 07.02.24

Subject: Affidavit - ANTONIA CORTEZ ESPIRITU
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*25964 — D190 COUNTY ATTORNEY - 1894454-1-rqst41 -
VICTIM COMPENSATION CHECK

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form

This application is for: “d Duplicate or NM 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
paae 2 of this form.

Antonia Cortez Espiritu (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, 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 g31 1.14 .(3)

Signed: (4)

Note. Alease atiach a copy of the wattant/check if available and/or any other
evidence that a watrant/check was originally issued.

(5) Subscribed_and swor: before me this Aist day of Jone 20 2 Y .

Lee
NOTARY Pup CARLOS LEON SUAREZ
Notary Pubiie - Arizona
Mastcopa County

My commission expires: Z, eaarad

Warrant/Eheck wumer 1000003010154050

Original Date of Issue
(if known) (7) 26-J U n-2023

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

C1 Payroll
OO For Services or Goods furnished

C1 Treasurer's refund/payment

Other: Victim Compensation Check: 1894454-1 - rqst41

WARRANT NUMBER

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY
PHOENIX, ARIZONA 3010154050
DATE
6-26-2023 91-2/4221
Three Hundred Eleven And 14/100 Dollars
$311.44
AMOUNT

PAY TO THE ORDER OF

Antonia Cortez Espiritu
Void After
365 Days

For Questivas - 602-500-1379 or email AP@MAIL. MARICOPA. GOY
MARICOPA COUNTY DEPARTMENT OF FINANCE

NOT NEGOTIABLE

WARRANT AMOUNT

RETAIN THIS FOR | PAYEE “TP WARRANT NO. | WARRANT DATE
YOUR RECORDS
VICTIM WITNESS 3010154050 06/26/2023 SH
INVOICE NUMBER | DIESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
GAXIF D190 230000025984 311.14;CA

O0000066893K 1894454-4-rgst41
230000025964

Paid date Amount

Warrant number: 30%

Amount Payee so
21L34 Antonia Cortes Espirty