STAMPED & REDACTED - FOR AGENDA ATTACHMENT - LAW OFFICE OF MICHELLE BELL.PDF

v
MAR) COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9* Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

Maricopa.gov

To: Clerk of the Board

From: Office of Budget & Finance, Accounts Payable
Date: 5/17/2024

Subject: Affidavit — Replacement of lost warrants

Please find attached 1 Affidavit for a lost warrant to be included on the next available
Board Agenda.

* The attached item has been researched to ensure the warrant in question has not
been cashed or previously re-issued.

e The original warrant is presumed lost.

Please call Joyce Maurmann at 506-1343 if you have any questions. Please return the
approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor.

Thank you.

Re: Warrant #3010180208 / LAW OFFICE OF MICHELLE BELL
Fund 100 — D190 GAX1D 240000017335

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

paae 2 of this form.
LAW OFFICE OF MICHELLE BELL (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 22-Apr-2024 (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 $2,822.85 -(3)

Signed:‘ AYR LL Bere (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 sworn to before me this _ 19 day of M OU 20 14 .

— =
GS LESLEY B PROPP
5) Notary Public - Arizona
Ug) Maricopa County

OTARY PUBLIC
Wea Commission # 581989

My Comm. Expires May 15, 2024

My commission ie

ay 19, 102

(seal)

Warrant/Check Numbe
rant cece meme" 13010180208

Original Date of Issue
a (if known) (7) 22-Apr-2024

Reason for original issue of Warrant/Check (8):
QO Payroll
O For Services or Goods furnished 5/17/24

O Treasurer's refund/payment iC
‘Other: Court judgment - attorney fees O

Law Offices of Michelle Bell

Pre anearcoesin
PHONE:
EMAIL:

May 13, 2024

I, Michelle Bell, authorize, Michelle Bell, to execute an affidavit on behalf of Law Offices of
Michelle Bell.

Sincerely,
Law Offices of Michelle Bell, PLLC

Michelle Bell