STAMPED & REDACTED - FOR AGENDA ATTACHMENT - RONDI NUNN.PDF

v
MAR) COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9* Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

Maricopa.gov

To: Clerk of the Board

From: Office of Budget & Finance, Accounts Payable
Date: 5-28-2024

Subject: Affidavit — Replacement of Lost Warrant

Please find attached one Affidavit for a lost warrant to be included on the next
available Board Agenda.

* 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 Walter Chang at 506-8747 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 : 240 / D300 — Parks and Recreation / Rondi Nunn

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: Numbe: is fi id
COUNTY OF MARICOPA Eo Be ction shock eniett

j 2 of this form,

Rondi Nunn a ee

Name/Claimant (1), being first sworn, upon oath deposes and says:

On or about ManUG 2UeS (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 $ 876.00 -(3)
Signed: VG (4)
LAC

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 ee me this YA day of Vi / d) Li 202 Y

NOTARY PUBLIC /

DONNA F, COOPER

MY COMMISSION # HH 416325
EXPIRES: July 23, 202 eal

ares a
7

My commission expires:
W327]

| Warrant/Check Number 3040158457

(if known) (6)

Original Date of Issue 17- Aug-2023
(if known) (7)

6/5/24
Reason for original issue of Warrant/Check (8):
C Payroll
For Services or Goods furnish

surer’s refund/payment
a | check presumed lost / fund : 240, initiated by the vendor and dept
Other:

ed / Refund Sales