STAMPED & REDACTED - FOR AGENDA ATTACHMENT - LAURA MCCUE.PDF

To:        Clerk of the Board 
From:       Office of Budget & Finance, Accounts Payable 
Date:       10-30-2023 
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.
•
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, 9th Floor. 
Thank you. 
Re:  Fund 226, 232, 506 ― D440 / Planning and Development  / Laura McCue 
Office of Budget & Finance 
301 W. Jefferson St., 9th Floor 
Phoenix, Arizona 85003 
P: 602-506-3561 
F: 602-506-4451 
Maricopa.gov

Application f o r a Duplicate or Stale-Dated Warrant/Check
A f f i d a v i t / C l a i m Form
This application
i
.
STATE OF ARIZONA
Note: N u m b e r s o n this form c o r r e s p o n d to
C O U N T Y O F M A R I C O P A
numbers on the Instruction sheet which is
Laura McCue
paae 2 of this form.
?NamelClammant????______??(1), being first sworn, upon oath deposes and says:
b o w r a o u t O 1 - S e p - 2 0 2 3
(date)(2) a warrant/check was issued to t h e
Jove 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, o r 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
erinthe sumof $
2
,
0
8
5
.
0
0
C 3 )
(4)
N o t e .
Please attach a copy o f the warrant/check i f available and/or any other
evidence t h a ta warrant/check was originally issued.
(5) Subscribed
e d e
before me this
_? 5 D
_day of C r t o b e c
20728.
NOTARY PUBLIC
(Sm,
AIDAN HIBERT
jecj
ires:
S s
Notary Public - Stateof Anzona
WyT
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l
g o t ?
S S )
eircoma ,
Warrant/Check Number
30101 59757
if known)
(6
ix?
Expires January 19, 2027
Original Date of Issue
0 1 - S e p - 2 0 2 3
if known)
(7
Reason for original issue of Warrant/Check (8):
O
Payroll
F o r
S e r v i c e s
o r
G o o d s
f u r n i s h e d
/ REFUND #22023101 CREDIT RECEIPT #R202317793
S
S
?
t r e a s u r e r ' s
refund/payment__
O t h e r :
/ original check presumed lost in the mail /fund
: 226
, 232 and 506/ initiated by Planning and Development

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