STAMPED & REDACTED ALBERT GARCIA.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: November 8, 2021
To: Clerk of the Board

From: Maria Meza
Department of Finance/Accounts Payable

Subject: _Affidavit- VC-19595 ALBERT GARCIA W#3010096404 8/23/21 $7800.00

Please find the attached Affidavit for a duplicate warrant to be included on the next

available Board Agenda.

e The attached items have been researched to ensure the warrant in question
have not been cashed or previously re-issued.

e The original warrant is lost.

Please return the approved Affidavits to my attention in the Department of Finance, Suite
960 or email to MARIAAMEZA@MARICOPA.GOV.
| may be reached at 602-506-1379 if you have any questions.

Thank you.

Re: Fund: 222, Dept. 220 Human Services, GAX1D 22*2842

11/3/2021

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form

This application is for: Duplicate or O stale-Datea (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA nuamers one Instruction sheet which is

VC-13535 ALBERT GARCIA (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 23-Aug-2021 (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

(3)

(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 Gua day of Avvemder _200/ . |

Chal & Canad

NOTARY PUBLIC

NOTARY PUBLIC
aN STATE OF ARIZONA
My commission expires: y \viaricopa County
" ; i” GERRICK S GARRETT

LV ay pa, POAL
VA

Wi ‘Check Number
arrant/Check Number 13010096484

Original Date of Issue ADP E tae vy
ee iron 23-Aug-2021 APPROVED
Reason for original issue of Warrant/Check (8): DATE___ _11/08/ ee

O Payroll
0 For Services or Goods furnished

0 Treasurer's refund/payment
Other; 2220 RENTAL ASSISTANCE CK- NOT RECEIVED BY VENDOR

D220
GAX1D 22-2842

COUNTY EXPENSE WARRANT

Seven Thousand Eight Hundred And 00/100 Dollars

PAY TO THE ORDER OF
ALBERT GARCIA

TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

DATE
08-23-2021

Void After
365 Days

WARRANT NUMBER
3010096484

91-2/1221

$7,800.00

AMOUNT

For Questions or email NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
‘YOUR RECORDS
ALBERT GARCIA 3010096484 08/23/2021 $7,800.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
GAX1D D220 220000002842 7,800.00

INV-0000179791 ROSEMARIE VALDEPENA RENTAL ASSISTANC

220000002842