REDACTED - FOR AGENDA ATTACHMENT - ALIA MONTELONGO- 3010148408.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.

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*20443 - 1908278-1-rqst18

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/ Claim Form

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

Name/Claimant

On or about 21-Apr-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

\to him/her in the sum of g09.07 .(3)

warrant/check be }

Signed:

is (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_ 26 day of Hay 20 Au.
_ Yum log

NOTARY PUBLIC °

VERONICA RAZO
Hotary Public - State of Arizona
MARICOPA, COUNTY

oe : Commission # 640692
My commission expires: Explres December 14, 2028

GEC 14, Jo gé (seal)

W. t/Check Number
arrant/Check Number 3010148408

Original Date of Issue
9 (if known) (7) 21 -Apr-2023

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

UO Payroll

O1 For Services or Goods furnished

[1 Treasurer’s refund/payment
Other: Never received check - Reg 18

04-21-2023

3848448408

91-2/1224

Fifty Nine And 07/100 Dollars
JF ¥ $59.07
PAY TO THE ORDER OF mane) AMOUNT
Alia Montelongo Ni , >
Void After * CHAIRMAN
ot ene 365 Days 4, sex a =_
GRAD

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

Shier pinanciay oemlene

NOT NEGOTIABLE

RETAIN THIS FOR
YOUR.RECORDS

PAYEE WARRANT NO.

WARRANT DATE | WARRANT AMOUNT |

230000020443

VICTIM WITNESS 3010148408 04/21/2023 $59.07
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
00000066462K 1908278-1-rast18 GAXIF D190 230000020443 59,07/CA

Setup | List

Y AN warrants (Unsaved filter) +
CI Agency Status Warrant number — Issued date Paid date Amount
(2000. i ve 301074408 AN21/2023———«120000am 4/30/20... 9.07)
Warrant number: 3019148408
Amount Payee Account

58.07  Alis Montelongo