STAMPED & REDACTED - FOR AGENDA ATTACHMENT - MARILU AYALA.PDF
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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: 5/13/2024 Subject: Affidavit — Replacement of lost warrant #3010154112 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 and is stale dated. 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 #3010154112 / Marilu O Ayala Fund 219 — D190 GAXIF 230000026099 Application for a Duplicate or Stale-Dated Warrant/Check Sama Affidavit/Claim Form This application is for: O Duplicate or 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. Marilu O Ayala (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 26-Jun-2023 (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 ¢/3.00 -(3) f Signed: M a rile a Ya la (4) Note: Please attach a copy of the watrant/check if available and/or any other evidence that a warrant/check was originally issued. aie : ad (5) Subscribed and sworn to before me this ei day of M cy 20.3 4. lis) NOTARY PUBLIC Notary Publ Seat Araona MARICOPA COUNTY — ; Commission # 640682 My commission expires: BE nae ES December 14, 2026 La gy ad G6 (seal) Warrant/Eheck Number 3010154112 | Original Date of Issue (if known) (7) 26-Jun-2023 5/29/24 Reason for original issue of Warrant/Check (8): - C Payroll 1 For Services or Goods furnished O Treasurer's refund/payment Other: Never received check - Req #11 - VC 1963625-1 PROENIX, ARIZONA DATE Seventy Three And 00/100 Dollars 3010154112 P| —_ $73.00 PAY TO THE ORDER OF AMOUNT Marilu Ayala Void After 365 Days Pox Questions - 602-506-1379 or email AP@MAIL. MARICOPA.GOV NOT NEGOTIABLE MARICOPA COUNTY DEPARTMENT OF FINANCE RETAIN THIS FOR | PAYER WARRANT NO. | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS VICTIM WITNESS 3010154112 06/26/2023 $73.00 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT 00000067030K 4963625-1-rast11 GAXIF D190 ' aie. - 230000026099 73,00 230000026099 gee: CA