STAMPED & REDACTED ALLAN G HOBBS.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: October 19, 2021
To: Clerk of the Board

From: Maria Meza
Department of Finance/Accounts Payable

Subject: _Affidavit- VC-13802 ALLAN G HOBBS W#3010098180 9/15/21 $4164.00

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 MARIALMEZA@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*4318

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

This application is for: 2 vuplicate or O 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.
(1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 15-Sep-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

ser LE in oo See 3)
Signed: _“/ Yn ae (4)

Cm

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_@(. day of Cetober 2021 .

NOTARY PUBLIC

My commission expires: SEE ATTACHED CALIFORNIA JURAT
O58 los | 2ozE-

Warrant/Check Number
(if known) (6)

Original Date of Issue

1

Reason for original issue of Warrant/Check (8):
O Payroll
1 For Services or Goods furnished Tasieetsie
O Treasurer's refund/payment oe

Other: 0220 RENTAL ASSISTANCE- CK NOT RECEIVED BY VENDOR

D220
GAX1D 22-4318

A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document.

State of California
County of San Diego

Subscribed and sworn to (or affirmed) before me on this_@G
day of _ October _, 2021, by Allan Cn. Hobbs —

proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.

PUBLIC © CAL! i
wor a DIEGO COUNTY RNA

BP romisson EXPIRES MAY 5, 5 as §

(Seal) Signatur

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
3010098180

PHOENIX, ARIZONA

DATE
09-15-2021 91-2/1221
Four Thousand One Hundred Sixty Four And 00/100 Dollars
PAY op $4,164.00
TO THE ORDER OF
ALLAN G HOBBS Le OUT
Void After
365 Days

For Questions - or email
MARICOPA COUNTY DEPARTMENT OF FINANCE

NOT NEGOTIABLE

WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

RETAIN THIS FOR | PAYEE
YOUR RECORDS
ALLAN G HOBBS 3010098180 09/15/2021 $4,164.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
GAX1D D220 220000004318 4,164.00

NICHOLAS WILKINSON RENTAL ASSISTANCE

INV-00004 16765
220000004318

Check Reconciliation

Check Reconciliation

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Bank Record Cleared
Account Check / EFT Amount = Issue Date Date Date Status Document
_# 1000 000003010098180 $4,164.00 09/15/2021 09/15/2021 Disbursed AD.D180,220000005975.1
From 1to1of1 First Prev Next Last
Copy Search
Bank Account: 1000 Doc Code : AD
Check / EFT : 000003010098180 Doc Dept : D180
Disbursement Type : yarrant | Doc ID : 220000005975
Amount: $4,164.00 Recently Reconciled : [_ |
Issue Date : 09/15/2021 Stopped Reason : NM]
Record Date : 09/15/2021 Stopped Date :
Last Action : 99/15/2021 Undelivered Reason : re
“Status: Disbursed [V] Undelivered Date :
Cancellation Reason : NS] Last Manual Update By :
Cleared Date : Reason for Change : :
Comments : .
WZ
Check Status Update Check Writer Payment Check/Deposit Manual Update Tracking
Check Exception Disbursement Detail Query Accrual Inquiry
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