STAMPED & REDACTED - FOR AGENDA ATTACHMENT - COMPUNNEL SOFTWARE GROUP INC.PDF
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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: 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. e 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, 9" Floor. Thank you. Re: Warrant #3010171591 / COMPUNNEL SOFTWARE GROUP, INC. Fund 255 — D260 PRM 240000018586 Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/ Claim Form This application is for: Duplicate or OU 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 page 2 of this form. COMPUNNEL SOFTWARE GROUP, INC gas ; ‘SamarCawnant (1), being first sworn, upon oath deposes and says: On or about 18-Jan-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, 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 $ 1,003.88 .(3) ; ey Signed: = (4) Note, Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. yas and sworn to before me this_X Zoi day of san 20 4 Mar. Grr, NOTARY PUBLIC PA My commission expites: Notary Public, State of New Jersey Sa My Commision Epes SFS72125 steeall Warrant/Check Number ea 3010171591 Original Date of Issue gn if nown) (7) 18-Jan-2024 Reason for original issue of Warrant/Check (8): O Payroll (4) For Services or Goods furnished CO Treasurer's refund/payment . 3/1/24 O Other: Compunnel Declaration for Authorized Signatory Dated- 2/27/2024 I, Rakesh Shah being President and Chief Financial Officer of Compunnel Software Group Inc, hereby solemnly affirm and declare that Sam Handa is hereby authorized, to act as an authorized signatory for the business. FRB Signature of the person competent to sign Name: Rakesh Shah Designation: CFO Name of the Business Entity: Compunnel Software Group Inc Acceptance as an Authorized Signatory I Sam Handa, hereby solemnly accord my acceptance to act as authorized signatory for the above referred business and all my acts shall be binding on the business. Signature of Authoriz Name: Sam Handa Designation: VP-Operations & Business Strategy Date 2/27/2024 a Inc.