STAMPED & REDACTED - CHRISTOPER T. FOSTER.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson, 9 Floor
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: December 28, 2022
To: Clerk of the Board
From: Yolanda Duran

Office of Budget and Finance

Subject: Affidavit — CHRISTOPHER T FOSTER

Please find attached 1 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 lost.
Please call me at (602) 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 766 — D180-FINANCE- GAX 23*00427
PSPRS Tiers 1 & 2 Excess Contribution Refund-Interest Portion Sept 2022
CHRISTOPHER T FOSTER

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

This application is for: 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
page 2 ofthis form.

CH RISTOPHER TFOSTER (1), being first sworn, upon oath:deposes.and says:
fal aman
On or about 23-Sep-2022 (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 1s 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 139. Of - a 3)
soe CAL ee oe

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

©) Subscribed and. sworn to before me this 2! “Hay of Decembe ie 20 =

Cina Kay tato

: NOTARY PUBLIC.

GINA KAY WIN :
‘Notary Pubile= Saran =
‘Maricopa County.
“Commission #635749,
Sty Comm. Expires Sep.12, 2026 |

My c commission expires:
G-12- C026

araniheck mane! 13010127840 —

| Ori inal Date of Issue 1D -
9 “(trove 23-Sep-2022

_ Reason for original issue of Woarrant/Check (8) :
oO 3 Payroll

ervices Or Goods furn

12/28/2022