STAMPED & REDACTED - FOR AGENDA ATTACHMENT - MARIE GANSSLE-KAIPELEA.PDF

To:        Clerk of the Board 
From:       Office of Budget & Finance, Accounts Payable 
Date:       2/28/2024 
Subject:  Affidavit ― Replacement of Lost Warrant 
Please find attached one 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.
•
The original warrant is presumed lost.
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, 9th Floor. 
Thank you. 
Re:  Warrant #3010174248 / MARIE GANSSLE-KAIPELEA 
Fund 675 ― D750 GAX1D 240000014081 
Office of Budget & Finance 
301 W. Jefferson St., 9th Floor 
Phoenix, Arizona 85003 
P: 602-506-3561 
F: 602-506-4451 
Maricopa.gov

Application for a Duplicate or Stale-Dated Warrant/Check 
• 
Affidavit/Claim Form 
This application is for: 0 Duplicate or D Stale-Dated (definitions are on page 2)
STA TE OF ARIZONA
Note: Numbers on this form correspond to
COUNTY OF MARICOPA
numbers on the Instruction sheet which is
oaoe 2 of this form.
MARIE GANSSLE-KAIPELEA (1), being first sworn, upon oath deposes and says: 
Name7Cla1manl 
On or about 20-Feb-2024 
(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, m: 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 $._5_8_3_.0_4 _______ .{3)
Note: Please attach a copy of the warrant/c. eek if available and/or any other 
evidence that a warrant/check was originally issued. 
(5) Subscribed and sworn to before me this
"--Z-1
NOTARY PU0
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'28 
day of h-ba
TREVOR C TURLEY 
Notary Public • Ar1Z0na 
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CommlsslOn t 622771 
2024 
ªcommission expires: 
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My Commission E)C)lres Jaroary SI. 2028 
(seal) 
Warrant/Oieck Number 
3010174248
(if knownl (6l 
Original Date of Issue 
20-Feb-2024
Ofknownl m 
Reason for original issue of Warrant/Check (8): 
D Payroll 
0 For Services or Goods furnished ______________ _ 
□Treasurer's refund/payment _______________ _
o Other: _____________________ _
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