REDACTED - FOR AGENDA ATTACHMENT - LORENA VALDEZ 3010154100.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 {NN 3010164395 / Lorena Valdez
MVICTIM

Fund 219 — D190 GAXIF 230000026072

Fund 219 — D190 GAXIF 240000008861

Affidavit/Claim Form

This application is for: CO 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
paae 2 of this form.
Lorena Valdez (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

ke //e to him/her in the sum of $1 10.85 .(3)
Signed: : he 7 (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_“3.<) day of _@ or \ | 20,24.

NOTARY PUBLIC

VERONICA RAZO
Notary Public - State of Arzona
MARICOPA COUNTY

os . : Commission # 640692
My commission expires Explres Decamber 14, 2026

(2 fid lak J (seal)

Wi t/Check Numb
arrant/Check Number 13010154100

Original Date of Issue
(if known) (7) 26-J u n-2023

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

1 Payroll

O1 For Services or Goods furnished

(1 Treasurer’s refund/payment

Other: Never received check - Req #16 - VC 1953579-1