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MARICOPA COUNTY Office of Budget and Finance 301 West Jefferson Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: August 18, 2021 To: Clerk of the Board From: Walter Chang Office of Budget and Finance Subject: Affidavits - Replacement of Lost Warrants Please find attached 1 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 506-8747 if you have any questions. Please return the approved affidavits to my attention in the Office of Budget and Finance. Thank you. Re: Fund:100 /Dept: Treasurer / Company: Nelia Gutierrez Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or C1 stale-Dated (definitions are on page 2) STATE OF ARIZONA Note: Numbers on this form correspond to COUNTY OF MARICOPA eee sheet which is Nelia Gutierrez (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 18-Mar-2020 (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 $ 70.60 .(3) Signed: Ptelite geliet fh ry (4) Note. Please attach a col, 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 _/4 iad day of Ags 202; . fa rw, , Natalie Hempelmann HOPARY PuELTe YES) sft sar f S= Commission No. 572844 My commission expires: na nd o7/2f 2023 (seal) Warrant/Check Number 905145 (if known) (6) Original Date of Issue (if known) (7) 18-Mar-2020 Reason for original issue of Warrant/Check (8): OO Payroll For Services or Goods furnished O Treasurer's refund/payment Other: / Original check presumed lost in the mail THe DOCUMENT CONTAINS A'THUE VATE RMARIC=HO = . MARIGOPA.COUNTY TREASURER) = =, - _ Ie ORA, COUNTY TREASURER = © ACHRT 1221000240 a i we =RVICING BANK ACCOUNT: * a PS Q4-2N224 © ve Teg ae ‘DATE eg “ 7 March 18 2020 5 : i Seventy Dollars and 60/100 ‘ : $70.60 2 ae / ; - CHECK VOID AFTER 365 DAYS a : Oe, MRE. Mt GUIIERRSY “ ~ MARICOPA, COUNTY TREASURER t ROYCE T. FLORA, COU EASURER || _ PHOENIX, AZ CET: FLQRy GOUN EE AUTHORIZED SIGNATURE iSecurity Features jncluded. ) wo s “e om aecicl eda ily rusclaceZt = Clock aus ¥ jusk Found | Gi oulch 4 ou plea po asa re Det h. a WN 2toO Check? (wis Gnho CQAaAS Uaideal ater 3 oT. dct ga Vl euro, Aud! Yee “7; Crow acre rp riey Week Gewon Lie: nae V d Pieler JP. faite U LS we at KKALOD — Wnradi\(imn — AXSeen ; AO lice