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35125VU.l nispG PURNELL, MER'.FON 1.0.U!; 1U.00
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Total Supp:.Ii i _)ayinents 1 7.0.:;0 0.00 .6.00
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KITTITAS COUNTY FIRE DISTRICT #2
Ellensburg, WA
RESOLUTION 12-19
SUBJECT: CANCEL AND REISSUE OUTSTANDING WARRANT
WHEREAS, Kittitas County Warrant #0361242863 for $10.00 issued November
14, 2011, to Merton Purnell, being lost and never being presented
to the Kittitas County Fire District 2 General Fund 636-010 for
payment is outstanding, and
I.AjHEREAS, Merton Purnell has presented a properly executed Application for
Duplicate Instrument Affidavit for the warrant, and now
THEREFORE, BE IT RESOLVED, that the Board of Fire Commissioners, Kittitas
County Fire District 2, by virtue of this resolution hereby declares
Warrant #03612428613 cancelled and instructs the Kittitas County
Auditor to reissue the warrant.
Adopted this 11th day of October 2012, at a regularly scheduled meeting of the Board of
Commissioners.
Board Chair
%Com missioner
Attest to:
'r -7 Commissioner
District Secretary Commissioner
Absent
Commissioner
"T 'CU FIRE DIS
li
-4
B&Lguirements Before issuance ofDqpficate Instruments
Before a duplicate instrument is issued, the issuing officer shall require the
person making laking application for its issue to file at the District Administrative office
at 102 N. Pearl Street, Ellensburg, Washington, a written affidavit specifically
alleging on oath that the individual is the proper owner, payee, or legal
representative of such owner or payee of the original instrument, giving the date
of issue, the number, amount, and for what services of claim or purpose the
original instrument or series of instruments of which it is a part was issued, and
that the sarne has been lost or destroyed, and has not been paid.
STATE OF WASHINGTON, } ss,
County of KITTITAS )
1, Merton Purnell, being first duly sworn upon oath, depose and say that I
am the proper owner, payee, or legal representative of such owner or payee of
Kittitas County Fire District #2 original Warrant NurnlDer 0361242563, dated
November 14, 2011, in the amount of Tele and 001100 dollars (:10.00) which said
instrument was issued in payment for rent on the Fairview Station land and that
the same has been lost or destroyed and has riot been paid.
Claimant Signature
Subscribed and sworn to before me this day of _, •
Ge Dei
Notary Public in and for the State of Washington,
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