REDACTED UNITED AIRLINES INC.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: November 18, 2021
To: Clerk of the Board
From: Marcia J. Bulanda

Department of Finance

Subject: Affidavit — UNITED AIRLINES INC.

Please find attached 1 Affidavit for stale dated 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 call me at 506-7291 if you have any questions. Please return the approved

Affidavits to my attention in the Department of Finance, Suite 960.

Thank you.

Re INIS 1S A warrant Lrom the Treasurer

TOLb SOLO OO00 LL46 Lro4

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/Claim Form

This application is for: Duplicate or (- State-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.
UNITED AIRLINES INC. (1), being first sworn, upon oath deposes and says:
Name/Craimanit
On or about 14-May-2020 (date)(2) a warrant/check was issued to the

above named person/entity in the amount as stated below. Such warrant/check was
aither never received or was subsequently inadvertently lost or destroyed and there is
no reasonable probability of its being found or presented for payment, er 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 481 ,089.53 (3)

é ft y
Signed: , Brclres. \ Ly 4 ne (4)

Note: Please attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

st
2

(5) Subscribed and sworn to before me this 3’ A day of Uivembee 2021.

NOTARY PUBLIC CU

My cornmission expires:
Moda | DF

{if known) {6} 908096

Original Date of issue { 4-May-2020

(if known) (7)

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

(1 Payroll
C1 For Services or Goods furnished

O Treasurer's refund/payment
Other. / Original check presumed lost in the mail

UNITED ®S

Signer Authorization

Andrea Campbell is authorized as an employee, to sign on behalf of United Airlines, Inc.
(“United”) and its operating subsidiaries.

All correspondence shall continue to be directed to United at the address below. The
contact information for Andrea Campbell is as follows:

Name: Andrea Campbell ;
Company: United Airlines, Inc.
Address:

Phone Number:

Signed Name: Ata Vib
7 a

Printed Name: Sara Trapp

Officer Title: Chief Tax Officer

Date Signed: il /2/2. ]