STAMPED & REDACTED GUADALUPE LEAON (2).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 C] 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
pade 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 ¢4.98 (3)
f! .
Signed: (VULYE \ ur Can — (4)

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

ae and sworn to before me this__| 7 day of Septem ber 2021.

NOTARY RUBLIC

RIE C MATTHEWS

yMARIORIS. State of Arizona:
Maricopa County

Commission # 548862

My commission expires: My Commission Expires

May 20, 2027. = May 20, 2022 (seal)
Warrant/Check Number ys 4
[Check Number 1999003010089521
Original Date of Issue
9 (if known) (7) 31 = May-2021
Reason for original issue of Warrant/Check (8): 10/05/2024

C1 Payroll =
1 For Services or Goods furnished

01 Treasurer’s refund/payment

Other: Victim Compensation: VC2013033559-3

2)

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
3010089521

PHOENIX, ARIZONA

DATE
05-26-2021 91-2/1221
Four And 38/100 Dollars
$4.98
PAY TO THE ORDER OF AMOUNT
Guadalupe Leon ww
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 3010089521 05/26/2021 $4.98
VOUCHER NO, AMOUNT

INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO.

00000061 204K VC2013033559-3-rgst9 GAXIF D190 210000017194 4.981CA
210000017194