REDACTED - FOR AGENDA ATTACHMENT - ALIA MONTELOMGO - 3010143798.PDF
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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: 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. 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 23*16219 - 1908278-1-rqst14 Application for a Duplicate or Stale-Dated Warrant / Check Affidavit/Claim Form This application is for: O 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 . paae 2 of this form. Alia Montelongo (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 28-Feb-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 béssued to him/her in the sum of g21 AT (3) Signed: (i (4) Note, Please attach a copy of the wartant/check if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this A % day of Ma v 2024. herni Ge NOTARY PUBLIC VERONICA RAZO Notary Public - State of Arizona BAARICOPA COUNTY . . Cr i # 640682 My commission expires: Expios Hocomisee 44, 2626 Cec 19, Bob (seal) Warrant/Check Number (it known) (6) 3010143798 Original Date of Issue (if known) (7) 28-Feb-2023 Reason for original issue of Warrant/Check (8): 1 Payroll © For Services or Goods furnished 0 Treasurer’s refund/payment Other: Never received check - Reg 14 ct y TERT ‘COUNTY EXPENSE WARRANT Twenty One And 77/106 Dollars PAY TO THE ORDER OF Alia Montelongo Soom PHOENIX ARIZON AS — oS bie oS DATE 02-24-2023 Void After 365 Days fe _ _———-__, $21.77 i AMOUNT HAIRMAN Ath OF oe See FINANCIAL OFFicen 8 For Questions - 602-506-1379 ot email AP@MATL.MARICOPA.GOV NOT NEGOTIABLE MARICOPA ‘COUNTY DEPARTMENT OF FINANCE RETAIN THIS FOR’) PAYER WARRANT NO. | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS VICTIM WITNESS 3010143798 02/24/2023 $21.77 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO, | AMOUNT O0000066066K 1908278-1-rqst14 GAXIF D180 230000016219 24,77|CA 230000016219 moro “¥ All warrants (Unsaved filter) + Warrant number: 3010143798 Amount Payee 21,77 Alia Montelonge (] Agency Status Warrant number — Issued date Paid date Amount : ~ [0 : : = 3010143798. 2/24/2023. 1200 am 2/29/20... - 277) Account