STAMPED & REDACTED - FOR AGENDA ATTACHMENT- AMY DAMIR.PDF

MAR COPA
COUNTY

Office of Budget & Finance To: Clerk of the Board
301 W. Jefferson St., 9" Floor

From: Office of Budget & Finance, Accounts Payable
Phoenix, Arizona 85003

Date: 01.04.24
Subject: Affidavit — Amy Damir

P: 602-506-3561
F: 602-506-4451

Please-find-attached-one-Affidavit for-a-duplicate-warrantio-be-ineluded-on-the-next-——-—

Maricopa.gov 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 Marcia Bulanda at 506-7291 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: D220 HUMAN SERVICES - FUND 296 - GAX1D 23*15137 — AMY DAMIR NURSE |
READINESS STIPEND

Application for a Buplicate or Stale-Bated Warrant/ Check

Afiidavit/Claim Form

This application is for: Duplicate or L] 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
AMY DAMIR |_ bade 2 of this form. ]
NSMOICISRIaN . _(4), being first sworn, upon oath deposes and says:
i
On-or-about 06-Jan-2023 co tdate)}(2)-a~warrant/check~wasissued-to~the i

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, ar 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 $990.00 3)
Signed: > OES Amy Dan we 4

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

(5) Subscribed and sworn to before me this’ 30th day of Decem ber 2023 .
Fee ee >
NOFARY PUBLIC P. CHEN &

COMM, # 2394570, &
Fr) NOTARY PUBLIC - CALIFORNIA

LOS ANGELES COUNTY 0
COMM, EXPIRES MAR. 16, 2026

My commission expires:
Mor. ib, 2Q0ab

(seal) !

_.

Wi t/Check Numb

Original Date of Issue
tenon) |06-Jan-2023

Reason for original issue of Warrant/Check (8): 1/04/2024
O Payroll ,

£1 For Services or Goods furnished__

(3 Treasurer’s refund/payment _
0 HU 3. - gt - SE READINESS STIPE
Other; 0220 HUMAN SERVICES - FUND 206 Gaxipasrsta7 AMY DAMIR NURSE READINESS STIPEND

TREASURER OF MARICOPA COUNTY WARRANT NUMEER

COUNTY EXPENSE WARRANT
- PHOENIX, ARIZONA 3010139564

fist git, CN
pag | | DATE
\ () Sars ] — 91-2/1224
egy
OUNS
Five Hundred And 00/100 Dollars
$500.00
PAY TO THE ORDER OF AMOUNT
Amy Damir
Void After
365 Days

For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV NOT NEGOTIABLE

MARICOPA COUNTY DEPARTMENT OF FINANCE

RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

YOUR RECORDS
MISCELLANEOUS VENDOR 3010139564 81/06/2023 $500.00
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
ARPA-NPP-12 AMY DAMIR NURSE READINESS STIPEND GAX1D D220 230000015137 500.00
230000015137

JP OMEN AOKES>