STAMPED & REDACTED - FOR AGENDA ATTACHMENT - ERIC ANDERSON.PDF
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SNE . at & MARICOPA | COUNTY G 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: 9-20-2023 Subject: Affidavit — Replacement of Lost Warrant P: 602-506-3561 F: 602-506-4451 Please find attached one Affidavit for a lost warrant to be included on the next Maricopa.gov 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 219 - D190- County Attorney / Eric Anderson Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/ Claim Form This application is for: Duplicate or C1 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 es page 2 of this form. Eric Anderson (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 29-Jul-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 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/check be issued to him/her in the sum of $474.34 (3) Signed: 5 ¢a/ Nyhan (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 Ve day of ete m 529923 | NOTARY PUBLIC NICOLAS DAVIS Notary Public - Arizona Pinal County My commission expires: commission #594256 [oi ace ca My Gornnt. texplran 1/72/2026 (seal) l Warrant/Check Number 204645650- 2 er (if known) (6) D0 lOKRZIO Original Date of Issue gel ee 25-Jul-2023 | Reason for original issue of Warrant/Check (8): . 9/20/2023 © Payroll 0 For Services or Goods furnished U1 Treasurer’s refund/payment Other: Victim Compensation Check: 1964524-1 Request 2 SOUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZONA 3010156510 DATE Four Hundred Seventy Four And 34/100 Dollars $474.34 PAY TO THE ORDER OF AMOUNT Eric Anderson tii, 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 3010156510 07/25/2023 $474.34 VICTIM WITNESS INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOURT GAXIF D190 240000001357 AT4.341CA 00000067278K 1964524-1-rqst2 240000001357