LEON.PDF

Maricopa County — Formal (2020-09-02)

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LERK ’
BOARD oF & SUPER VISO (no
SOR'S \

MARICOPA COUNTY MARICOPA couNs
Department of Finance Qewer
301 West Jefferson, Ste 960 “2 AUG17 AMI: 5¢

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: August 17, 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: 219 / Dept: 190/ County Attorney / Company : Guadalupe Leon

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: 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 tne Instruction sheet which is
Guadalupe Leon (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 92/28/2020 (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/cféek be issued to him/her open 19 (3)
Signed: Woody J (4)

Note. Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was aviginally issued.

e this }) day of 2072

CONNIE FRITZ
Noiery Public - State of Arizona
MARICOPA COUNTY

My commission expires: BSE) Commission # 858145
< _Expires August 17, 2023 (seal)

Warrant/Check Kumber 13949954346

(if known) (6)

Original Date of Issue 02/28/2020

(if known) (7) ee

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

PROVED |
os AUG 17 2020,

PERK, BOARD OF SU ORS
MARICOPA COL ivi

C1 Payroll E
C1 For Services or Goods furnished _

C1] Treasurer's refund/payment
Other: Victim Compensation: VC2013033559-1

counryexrensewarrant TREASURER OF MARICOPA COUNTY — WARRANT NUMBER

PHOENIX, ARIZONA 3010054346
DATE
02-28-2020 7
JPMorgan Chase Bank N.A 91-2/1221
Phoenix, AZ

Two Hundred Eighty Five And 19/100 Dollars

PAY TO THE ORDER OF
Guadalupe Leon

301 W Jefferson 9th Floor
PHOENIX AZ 85003

For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF FINANCE

$285.19
AMOUNT
Void After
365 Days
NOT NEGOTIABLE

RETAIN THIS FOR | PAYEE

WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

YOUR RECORDS
VICTIM WITNESS 3010054346 02/28/2020 $285.19
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
00000056598K VC2013033559-1-rqst4 GAX1D D190 200000028918 247.50/CA
200000028918
00000056598K VC2013033559-1-rgqst5 GAX1D D190 200000028918 37.69|CA
200000028918

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