REDACTED - FOR AGENDA ATTACHMENT -ALIA MONTELONGO - 3010146009.PDF

MARICOPA
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: 06.04.24

Subject: Affidavit — ALIA MONTELONGO

Please find attached one Affidavit for a stale dated 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.

« 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 23*18385 - 1908278-1-rqst16

Application for a Duplicate or Stale-Dated Warrant/ Check A

Affidavit/Claim Form

This application is for: C Duplicate or 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
. pade 2 of this form.
Alia Montelongo (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 31-Mar-2023 (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 ly to him/her in the sum of $32.65 (3)
Signed: 2 (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, @ Ss day of May 2AY.

co

NOTARY PUBLIC

Oo

VERONICA RAZO
MARICOPA COUNTY
a oe ICOPAG
My commission expires: Commission # 640892
Cee 14, Bos Expires December 14, 2026 (seal)

Warrant/Check Numb:
litkmoun) (6) (0010146009

Original Date of Issue
9 (if known) (7) 31-Mar-2023

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

O Payroll

OO For Services or Goods furnished

0 Treasurer’s refund/payment
Other: Never received check - Req 16

Thirty Two And 65/100 Doltars

PAY TO THE ORDER OF

Alia Mo

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

—PHOENIXJARIZONA fj. ati

DATE

Void After Ei

365 Days

NOT NEGOTIABLE

RETAIN THIS FOR | PAYEE

YOUR RECORDS

WARRANT NO. | WARRANT DATE | WARRANT AMOUNT |

VICTIM WITNESS

3010146009 | 03/23/2023 | $32.65 |
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO, | VOUCHER NO. AMOUNT
00000066268K 1808278-1-rqst16 GAXIF D190 230000018385 32.65] CA

| 230000018385

“e AM warrants (Unsaved Miter +

CO Agency Status Warrant number — issued date Paid date Amount
v > [3010146009 + . . .
< 3010146009. 3/23/2023... 12:00:00am_ 3/28/20... 32,65;
Warrant number 3010746009
Amount Payee Account

32.65 Alia Mantelango