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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 \ Phoenix, Arizona 85003 cLeRK BO! RD OFS Son BOUNTY PASC PERVISORS INTEROFFICE MEMORANDUM : = 2 Hee > wr yan ea Cptee Ban" tt <2 n Date: August 27, 2020 To: Clerk of the Board 62: Wd L2 ONY 0282 From: Walter Chang Department of Finance i 8.8 “sc 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: 219 / Dept: 190- County Attorney / Company: Craig Nelson 1c sh 2 ARIZONA ae Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/ Claim Form OUN Sa This application is for: ra Duplicate or C 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. Cag Nel Son (1), being first sworn, upon oath deposes and says: Name/Cigimant * On or about 01-Apr-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 ¢1 068.85 .(3) Signed: —<ee, D (4) Note: Aes cetach 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 day of _/) Lgvs s fb 20_20. WA (ne 2 (a rao, alee bon NOTARY PUBLIC VERONICA RAZO Notary Public - State of Arizona MARICOPA COUNTY My comm nmission sx expires: Neen ber 6, 2022 (seal) [Warrant/Check Number QQ 4NNER2QRQ | arrant/Check Number 130410056368 Original Date of I rig (if iene o 0 1 -Ap r-2020 Reason for original issue of Warrant/Check (8): O Payroll C1 For Services or Goods furnished O Treasurer's refund/payment Other: Victim Compensation Check