STAMPED & REDACTED GUADALUPE LEAON (1).PDF

MARICOPA COUNTY

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

INTEROFFICE MEMORANDUM

Date: October 5, 2021
To: Clerk of the Board
From: Nadine Higuera

Department of Finance

Subject: Affidavits — Replacement of Lost Warrants

Please find attached 2 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 506 - 3154 if you have any questions. Please return the approved

Affidavits to my attention in the Office of Budget and Finance.

Thank you.

Re: Fund: 268 /Dept:190— County Attorney / Company : Guadalupe Leon

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

This application is for: Duplicate or CJ 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
paae 2 of this form.
Guadalupe Leon (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 31-May-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 $ 142.72 (3)

Signed: re \nhye (Pee (4)

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

Subscribed and sworn to before me this _/ an day of Septem loer 2021.

"NOTARY hee

MARJORIE C MATTHEWS
Notary Public, State of Arizona’
Maricopa County
Commission # 548862
My Commission Expires .
May 20, 2022 (seal)

My commission expires:
7 An, ee) fl LO22
[oy

Warrant/ene a" |000003010089520

Original Date of Issue
9 (if known) (7) 31 -May-2021

Reason for original issue of Warrant/Check (8): 10/05/2021

O Payroll
CJ For Services or Goods furnished

C1 Treasurer's refund/payment

Other: Victim Compensation: VC2013033559-3 rast 7

2

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
3010089520

PHOENIX, ARIZONA

DATE
05-26-2021 94-2/1221
One Hundred Forty Two And 72/100 Dollars
$442.72
PAY TO THE ORDER OF AMOUNT
Guadalupe Leon a
Void After
365 Days
NOT NEGOTIABLE

For Questions - or email
MARICOPA COUNTY DEPARTMENT OF FINANCE

RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

YOUR RECORDS

VICTIM WITNESS 3010089520 05/26/2021 $142.72 |
VOUCHER NO. AMOUNT |

INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO.

00000061202K VC2013033559-3-rqst7 GAXIF D190 210000017192 142.72|CA
210000017192