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MARICOPA COUNTY f Department of Finance FARICOPD 301 West Jefferson, Ste 960 of . ; Phoenix, Arizona 85003 RENOV-9 PH 4:23 INTEROFFICE MEMORANDUM Date: November 9, 2020 To: Clerk of the Board From: Walter Chang Department of Finance Subject: Affidavits - Replacement of Lost Warrants Please find attached 1 Affidavits for lost warrants to be included on the next available Board Agenda. e The attached items have been researched to ensure the warrant in question have not been cashed or previously re-issued. e The original warrants have a void/stale date/stop payment done. Please call me at 506 - 8747 if you have any questions. Please return the approved Affidavits to my attention in the Department of Finance, Suite 960. Thank you. Re: Fund: 100 / Dept: D110 - Adult Probation / Company : AZ SUPREME COURT Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or C1 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. AZ SUPREME COURT (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 16-Sep-2020 (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 $22,587.75 .(3) Signed: ( Onoutt Lau pA (4) Note. Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this _ a day of N 2v emb © 90 20. [Parle — NoARY PUBLIC =“ ._) My commission expires: Tanne ©) 2024 tees Warrant/Check Number (if known) (6) 3010066582 Original Date of Issue (if known) (7) 16-Sep-2020 Reason for original issue of Warrant/Check (8): Ov 12 2020 1 Payroll For Services or Goods furnished C1 Treasurer's refund/payment Other: Original check presumed lost in the mail Supreme Court STATE OF ARIZONA ADMINISTRATIVE OFFICE OF THE COURTS ROBERT BRUTINEL DAVID K. BYERS CHIEF JUSTICE ADMINISTRATIVE DIRECTOR OF THE COURTS October 29, 2020 I, Martin Gaxiola, authorize Candy Frazier, Finance Manager, to execute an affidavit on behalf of Arizona Supreme Court - Administrative Office of the Courts (AOC). Yours truly, Maftin Gaxiola CPA, CFE Chief Financial Officer Arizona Supreme Court Administrative Office of the Courts Phone: (602) 452-3327 Cell: (602) 663-1104 oa 1501 WEST WASHINGTON STREET © PHOENIX, ARIZONA 85007-3222 © 602-452-3300 (TDD) 602-452-3545