STAMPED & REDACTED - FOR AGENDA ATTACHMENT - LESLIE VIVERETTE.PDF

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: 06.05.24

Subject: Affidavit — LESLIE VIVERETTE

Please find attached one Affidavit for a duplicate warrant to be included on the next
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 —- D190 COUNTY ATTORNEY ~ GAXIF 24*23003 - 1997129-1-rqst2

Application for a Duplicate or Stale- Dated Warrant/Check

Affidavit/ Claim Form

This appiication is for: Duplicate or (J stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this forrn correspond to _
COUNTY OF MARICOPA numbers on the Instruction sheet which is
. . paae 2 of this form.

Viverette, Leslie {1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 18-Apr-2024 (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 iost 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 penaity of perjury, claimant hereby affirms that this cdaim is correct
and the arnount shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her | in the sum of 62, 870.00 ert G3)
&
Signed: Cele % en et. 7) (4)

Note. Pfease 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 Z yy day of M day 20 24.

fh, (a ae a i {ons L, 3
NOTARY PUBLIC

commission expires:

BREANNE GONZALES
Notary Public - Arizona
Pinal County
Commission # 664577
+ Commission Expires Fi f

Warrantfcheck number” 19Q0003010179668

Original Date of Issue
8 (known) (2) 18-Apr-2024 6/5/24

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

C1 Payroll
For Services or Goods furnished

{] Treasurer's refund/payment

Other; Victim Compensation Check: 1997129-1 Req 2

~~ eounry expense warrant FREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010179668

DATE
04-18-2024

Fe —_

Two Thousand Eight Hundred Seventy And 00/100 Dollars

$2,870.00
PAY TO THE ORDER OF AMOUNT
Leslie Viverette a eae
Void After
365 Days ; i
For Questions - 602-506-1379 or email AP@MATL.MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THISFOR [PAYEE WARRANT NO, | WARRANT DATE | WARRA NT AMOUNT |
YOUR RECORDS - . . - .
____ [VICTIM WITNESS . 3010179668 04/18/2024 $2,870.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
00000069913K 1997129-1-rqst2 GAXIF D190 240000023003 2,870.00}CA

240000023003

|

¥ issued warrants (Unsaved fitter) ~ |
oO Agency Status Warrant number — Issued date Paid date Amount
: + Issued 3OIO17S663. . ¥ . |

| be | 3010179668 48/2024 12:00:00am oe SBE,

Warrant number: 20101 7ot62

Amount Payee Account

2S7G.00 Leslie Yiverette