REDACTED - FOR AGENDA ATTACHMENT - LORENA VALDEZ 3010164395.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: 5/06/2024

Subject: Affidavit — Replacement of lost warrants

Please find attached 2 Affidavits for lost warrants 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 #3010154100 & NN / Lorena Valdez
MVICTIM

Fund 219 — D190 GAXIF 230000026072

Fund 219 — D190 GAXIF 240000008861

CTD,

Application for a Duplicate or Stale-Dated Warrant/ Check fe Ae 7”

This application is for: CO Duplicate or Stale-Dated (definitions are on page 2)

Affidavit/Claim Form

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.
Lorena Valdez (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 25-Oct-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

a CL issued to him/her in the sum of g09.43 .3)

Signed:

jes (4)
fe C4
Note? Please attach 2 copy of the watrant/check if available and/or any other

evidence that a warrant/check was originally issued.

(5) Subscribed and sworn to before me this  d day of fhe al 20_A¢

eben bee
NOTARY PUBLIC

VE RONICA RAZO

S) Muto - Stale of Arizona
My com ev EY. ires: ¥ Bs :

(seal)

Warrant/Check Number
(it known) (6) 3010164395

Original Date of Issue
9 (if known) (7) 25-Oct-2023

Reason for original issue of Warrant/Check (8):

O1 Payroll!

OO For Services or Goods furnished

C1 Treasurer’s refund/payment

Other: Never received check - Req #24 - VC1953579-1