STAMPED & REDACTED - SHORALL MCGOLDRICK PC.PDF

MARICOPA COUNTY

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

INTEROFFICE MEMORANDUM

Date: January 5, 2023
To: Clerk of the Board
From: Marcia J. Bulanda

Office of Budget and Finance

Subject: Affidavit - SHORALL MCGOLDRICK PC, SHORALL MCGOLDRICK ZERLAUT

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 if you have any questions. Please return the approved

Affidavit to my atteniion in the Office of Budget and Finance, 9"" Floor.

Thank you.

Re: FUND 675 — D750 — RISK MANAGEMENT — GAX 23*8339 -- GL504118000479 MONTEZ

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

This application is for: Duplicate or [2] 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 fs
nade 2 of this form.

SHORALL MCGOLDRICK PC (2), being first sworn, upon oath deposes and says:
Namercraimant SHORALL MCGOLDRICK ZERLAUT

On of about 14-Oct-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 is correct
and the amount shown is due and owing, and the applicant requests that a replacement

warrant/chedh be issued to him/her in the sum of $ 4,175.00 (3)
Signed: AW fv Sone, (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 Yih _day of Qos 20S.

NOTARY PUBLIC

ROSELYN 0, MOSBRUCKER
Notary Pubile « Arizona
Maricopa County

My commission expires:
&[7(d-03 Ce

Commisston # 630552
My Comm, Expires Aug 7, 2026

(seal)

(if known) (6)

Original Date of Issue
(if known) (7) 44-Oct-2022

1/09/2023

Reason for original issue of Warrant/Check (8): “
1 Payroll
C1 For Services or Goods furnished

(2 Treasurer's refund/payment
Other: / original check presumed lost in the mail

FUND 875 - D750 RISK MANAGEMENT - GAXID 23*8338 -- GL6041 18000479 MONTEZ

..Shorall. McGoldrick.zerdaut - a _..1232 east missouri avenue

attorneys =* litigation « mediation phoenix, az 85014
602.
fax 602.
paul |. megoldrick writer's direct line: 602.

certified speclaiist in personal injury
& wrongtul death ligation ~ arizona
board of legal specialization

January 4, 2023

Maricopa County

Department of Budget and Finance
ATTN: Accounts Payable (Marcia Bulanda)
301 W. Jefferson, 9t Floor
Phoenix, Arizona 85003

RE: Affidavit/claim for re“issuance of a lost check
Dear Ms. Bulanda:
Enclosed please find your “Affidavit/Claim Form” which has been signed by Dawn
Bosio and notarized. Ms. Bosio is authorized to sign the form on behalf of the firm.

Kindly provide the requested re-issued check to the address on this letterhead.
Please feel free to call me with any questions. Thank you.

Paul M Goldrick
For the Firm

PIM/rm
Enclosure
Cc: Maxine Mak

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER

PHOENIX, ARIZONA 3010131173
- DATE
10-14-2022 91.2/1224
Phoenix, AZ

One Thousand One Hundred Seventy Five And 00/100 Dollars

. $1,175.00
PAY TO THE ORDER OF
SHORALL MCGOLDRICK PC allan
SHORALL MCGOLDRICK ZERLAUT .
Void After
365 Days

Fer Questions - 602- or email NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE.
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
SHORALL MCGOLDRICK PC 3010131173 10/14/2022 $1,175.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
42456 GL504118000479 MONTEZ GAX1D D750 230000008339 4,175.00

230000008339