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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 rn MO FEB jL Pfl 3: 17 0.(1\tj`Ai INTEROFFICE MEMORANDUM Date: February 14, 2020 To: Clerk of the Board From: Beth Brown Department of Finance Subject: Affidavit — Replacement of Lost Warrant Please find attached affidavit for 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. • The original warrant has a void/stale date/stop payment done. Please call me at 506-1329 if you have any questions. Please return the approved Affidavit to my attention in the Department of Finance, Suite 960. Thank you. Re: Volcanic Manufacturing LLC Dept. D500 Fund 100 ibsc(ied apd pyorr ii to before me this 1 day of TO9Vu vi 20 7-0 . ‘,41 I1t IC' My commission expires: Oh 5 / 202 5 KRISTINA S ANDERSON Notary Public State of Washington Commission # 208734 My Comm. Expires Jul 15, 2023 seal) Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate Or 0 Stale-Dated (definitions are on page 2 STATE OF ARIZONA COUNTY OF MARICOPA Note: Numbers on this form correspond to numbers on the Instruction sheet which is 'Dade 2 of this form. '//7'71:1777 (1), being first sworn, upon oath deposes and says: On or about 20-Dec-2019 (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 $ 4,405.14 .(3) Signed: (4) Note: PleW., attach a cclav,of the warrant/check if available and/or any other evidence that a warrant/check was originally issued Warrant/Check Number (if known) (6) Original Date of Issue (if known) (7) 3010050312 20-Dec-2019 Reason for original issue of Warrant/Check (8): El Payroll For Services or Goods furnished Patrol Bicycles 1E1 Treasurer's refund/payment IA Other: February 6, 2020 1, Eric Kackley, authorize ien,ller Kackky, Office Manager, to execute an affidavit on bPhalf of Vokanic Th:5,nk You, Eric Kackley 7C-- - - President ericPvoicanicbikes.corn \\Ay volcanicbi kes.corn 509-427-8623 P.O. Box 334 -Noral Bonneville WA 98639