STAMPED & REDACTED - FOR AGENDA ATTACHMENT - MICHELLE REDMOND.PDF

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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: 3-5-2024

Subject: Affidavit — Replacement of Lost Warrant

Please find attached one Affidavit for a lost warrant to be included on the next
available Board Agenda.

e 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 Walter Chang at 506-8747 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: Fund 241 / D300 - Parks and Recreation / Michelle Redmond

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form

This application is for: Duplicate or [7] stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to

COUNTY OF MARICOPA npibernon the Metin sheet which is
Michelle Redmond ; - ;
—RemaClanant (1), being first sworn, upon oath deposes and says:

On or about 28-Nov-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
ino 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

oi issued to him/her in wel of $438. 00 3)
Signed: Ah VOX Ay, (4)

Note, Please atiach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) Subscribed 7 sworn to before me this S87 day of CL fyolY oe
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TARY PUBLIC

| Ys ‘commission expires:
435, 2027

(seal)

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Warrant/Check Number
ede Ses * |3010167118 |
Original Date of sue 28-Nov-2023 __3TIA

Reason for original issue of Warrant/Check (8):
) Payroll
@ For Services or Goods furnished / Refund Sale #1501796

Treasurer's refund/payment os
(4 Other: / check presumed lost /fund : 241 P ‘initiated by D300._TF

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