STAMPED & REDACTED - FOR AGENDA ATTACHMENT- CHASE SALINAS.PDF
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a By NY 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: 07.28.23 Subject: Affidavit — Chase Salinas 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. « 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: Victim Compensation Check: 1911299-1, req #3 Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/Claim Form This application is for: Duplicate or CJ stale-Dated (definitions are on page 2) STATE OF ARIZONA COUNTY OF MARICOPA Chase Salinas Note: Numbers on this form correspond to numbers on the Instruction sheet which is paae 2 of this form. Name/Claimant On or about 28-Feb-2023 (1), being first sworn, upon oath deposes and says: (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 fost 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 warranticheck ps issued to him/her in the sum of $272.00 We fo a (4) Note. Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. (3) Signed: (5) Subscribed ‘i sworn to ii this 2 day of “So Ly 2024 . AAA Nariel / Ly NOTARY PUBLIC am ON notary Publ. " rivona My co my n expires: cotericape ot J 2,/ GES ow Ss” ly Comm. Expires Dec 3, 2025 (seal) Warrant/Check Number Check Nu 00000301014381 1 Original Date of Issue 8/2/2023 Reason for original issue of Warrant/Check (8): O Payroll (1 For Services or Goods furnished O Treasurer's refund/payment Other: Victim Compensation Check: 1911299-1, req #3 COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZONA 3010143811 DATE 02-24-2023 91-2/4221 Two Hundred Seventy Two And 00/100 Dollars $272.00 AMOUNT PAY TO THE ORDER OF Chase Salinas 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 QUR-RECORD VICTIM WITNESS 3010143811 02/24/2023 $272.00 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT 00000066074K 4911299-1-rqst3 GAXIF D190 230000016225 272.00]CA 230000016225