STAMPED & REDACTED OT'S BARBER SCHOOL AND SUPPLIES LLC.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: August 16, 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: 222 /Dept: Human Services / Company: OTs Barber School and Supplies LLC

COUNTY EXPENSE WARRANT

(sitive
os)

OuNS

Nine Thousand And 00/100 Dollars

PAY TO THE ORDER OF

OTs Barber School and Supplies LLC

For Questions -

or email

MARICOPA COUNTY DEPARTMENT OF FINANCE,

TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

DATE
06-18-2021

Phoenix, AZ

Void After
365 Days

WARRANT NUMBER
3010091132

91-2/1221

$9,000.00

AMOUNT

NOT NEGOTIABLE

RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
‘YOUR RECORDS
OTs Barber School and Supplies LLC 3010091132 06/18/2021 $9,000.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
185 1572 FERNANDEZ OSY WV GAX1D D220 210000027924 6,000.00
210000027924
184 8580 CONTRERAS OSY WV GAX1D D220 210000027925 3,000.00

210000027925

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 numbers on the Instruction sheet which is
paae 2 of this form.

OTs Barber School and Supplies LLC (1), being first sworn, upon oath deposes and says:
Name/Claimant

On or about 18-Jun-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 $ 9,000.00 .(3)

Signed: Of, —_ (4)
Co

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 _3°¢ day of Auguss 20.21.
NOTARY PUBLIC NOTARY PUBLIC” ARIZONA
COMMISSION # 603306
My commission expires: 5 MY COMMISSION EXPIRES
209s (seal)

(if known) (6)

Original Date of Issue _ _ 08/16/2021
(if known) (7) 18-Jun-2021 /16/

Reason for original issue of Warrant/Check (8):
1 Payroll
For Services or Goods furnished_/ tuition for hair styling

O Treasurer's refund/payment
Other; / Original check presumed lost in the mail / fund : 222

August 3, 2021

Maricopa County Department of Finance
ATTN: Accounts Payable

Phoenix, Az.
To Whom It May Concern, |

|, Faith Facio, authorize Otoniel Facio, Co-Owner, to execute an
affidavit on behalf of OT’s Barber School and Supplies, LLC.

The updated mailing address is:

Phoenix, AZ, |

Sincerely, |

Faith Facio

Co-Owner