REDACTED - FOR AGENDA ATTACHEMENT - TENO1 OWNER LLC AFFIDAVIT_REDACTED.PDF

MARICOPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9 Floor
Phoenix, Arizona 85003

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

Maricopa.gov

To: Clerk of the Board
From: Office of Budget & Finance, Accounts Payable
Date: 5.9,23

Subject: Affidavit — TENO1 Owner LLC

Please find attached one Affidavit for a lost warrant to be included on the next
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 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: Stale Dated - Fund 296 — D220 — Rental Assistance - Chatman, Montiah - GAX1D
22*12701

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form

This application is for: Cl Duplicate or 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
pade 2 of this form.
TENO' OWNER LLC (1), being first sworn, upon cath depases and says:
ETE
On or about 28-Dec-2021 (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 payrnent within one year after the date of issuance.

Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct
and the arnount shown is due and owing, and the applicant requests that a replacement

watrant/chee e issued to him/her in the sum of $ 13,199.79 (3)

Signed: ©. HX Oe 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.

(5) Subscribed and sworn to before me this 412" day of _érch 2043.
Wolo S. Scott
NOTARY PUBLIC _ MARILYN § WRIGHT
OTARY PUBLIC - STATE OF
3 MARICOPA GOURTY.

COMMISSION # 561327

My commission expires: lay Comm Exp aor 302

(seal)

Warrant/Check Number | 3949496300

Gf known) (6)

Original Date of Issue 5
(if known) () 28-Dec-2021

Reason for original issue of Warrant/Check (8):

Cl Payroll
C1 For Services or Goods furnished

C1 Treasurer's refund/payment _.
fF Other: STALE DATED - FUIND 296 - 2220 - RENTAL ASSISTANCE - CHATMAN, MONTIAH - GAX1D 22*42704

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Ten01 Owner (DE) LLC
c/o Oxford Properties Group

Attention: Benjamin Kayden, Senior Director, Legal

March 20, 2023

To Whom It May Concern,

|, Benjamin Kayden, am an officer of TenO1 Owner (DE) LLC, a Delaware liability company (the
“Company’”). On behalf of the Company, | hereby authorize Derek Lehn, Controller of Mark-
Taylor Companies, to execute an “Affidavit/Claim Form Regarding A Request for Either A
Duplicate Or Stale-Dated Warrant/Check” on behalf of the Company.

Sincerely,

Ayr

Benjamin Kayden
Assistant Secretary of Ten01 Owner (DE) LLC