STAMPED & REDACTED RBG COUNSELING & CONSULTING-JOY TODD.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson , Ninth Floor
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUN
Date: November 1, 2021
To: Clerk of the Board
From: Nadine Higuera

Office of Budget and Finance

Subject: Affidavits - Replacement of Lost Warrants

Please find attached 1 Affidavits for lost warrants 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 warrants have a void/stale date/stop payment done.

Please call me at 602 506 — 1354 if you have any questions. Please return the
approved affidavits to my attention in the Office of Budget and Finance.

Thank you.

Fund 268, Dept County Attorney, RBG Counselling and GAX1F 21*18652/GAX1F
Consulting 21*18716

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

This application is for: Duplicate or 1) 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
pace 2 of this form.

RBG Counseling and Consulting Joy Todd.(1) being first sworn, upon oath deposes and says:
Name/Claimant

On or about 30-Jun-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

warrant/check be issued to him/her in the sum of ¢825.00 (3)

Signed: (\ [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.

(5) Subscribed and swosn to before me this 4H day of October 2021.

Ah hun

NOTARY PUBLIC “7g? 3

ft ABE MCKAY
NOTARY PUBLIC - ARIZONA
Maricopa County

My commissi n expires: WA Kke
\ }5/2022, ,<

) (seal)
Warrant/Check Number
(it known) (6) 3010091579
Original Date of Issue
(if known) (7) 30-Jun-2021
Reason for original issue of Warrant/Check (8): 11/02/2021

C] Payroll
OO For Services or Goods furnished

[1 Treasurer’s refund/payment
Other: Victim Compensation Check: 1842153-1 for Req. 4 & 1779533-1 for Req. 13.

WA

COUNTY EXPENSE WARRANT

Eight Hundred Twenty Five And 00/100 Dollars

PAY TO THE ORDER OF

For Questions -

or email

MARICOPA COUNTY DEPARTMENT OF FINANCE

TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

DATE
06-23-2021

Void After
365 Days

WARRANT NUMBER
3010091579

91-2/1221

$825.00

AMOUNT

NOT NEGOTIABLE

RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
RBG Counseling and Consulting 3010091579 06/23/2021 $825.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
00000061295K 1779533-1-rqst13 GAXIF D190 210000018652 82.50/CA
210000018652
00000061362K 1842153-1-rqst4 GAXIF D190 210000018716 742_50|CA

210000018716

Rise RBG Counseling and Consulting
Build
Grow

To Whom it May Concern:

Joy Todd, LPC is authorized to sign documents on the behalf of business entity RBG Counseling
and Consulting.

Thank you,

Joy Todd, LPC

12

Arizona Corporation Commission Corporations Division

Website Entity Detail.

Entity Details
: RBG COUNSELING AND Lom.
Entity Name: CONSULTING LLC Entity ID: 23036295
Entity Type: Domestic LLC Entity Status: Active
Formation Date: 11/10/2019 Reason for Status: In Good Standing
Approval Date: 11/12/2019 Status Date:
Original Incorporation Date: 11/10/2019 Life Period: Perpetual
Business Type: — and Soeul Last Annual Report Filed:
Domicile State: Arizona Annual Report Due Date:
Years Due:
Statutory Agent Information
Name: Joy Todd Appointed Status: Active 11/12/2019
Attention:
Address: Agent Last Updated: 11/12/2019
Attention: Mailing Address:
E-mail; County: Maricopa
Principal Information
: Date of Taking Last
Title Name Address Office Updated
Member and RBG Counseling and
Manager Consulting 11/10/2019 11/12/2019
Entity Known Place of Business
Address: County: Maricopa Last Updated: 11/12/2019
Arizona Corporation Commission Page 1 of 2

TAIAINONNA 19-4619 DRA