STAMPED & REDACTED - 3RD AVE GG LLC.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: = 2-14-2023

Subject: Affidavit — Replacement of Lost Warrant

Please find attached one Affidavit for a lost warrant to be included on the next
available Board Agenda.

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 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 222 — D220- Human Services / 3RD AVE GG LLC

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or C1] state-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA anes eon sheet which is
3RD AVE GG LLC (1), being first sworn, upon oath deposes and says:

Nameé/Claimant

On or about 30-Dec-2022 (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 amoun au is due and owing, and the applicant requests that a replacement

ts TAC) er in um of $f, 014.15 (3)
Signed: Ab i (4)

Note: es hed okech a@ copy of et nk warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) Subsgfibe@ and sworn to before me this oF day of tebrs 20.2
Ts

NOTARY PUBLIC

My commisyion expires:
ofa k aon

Warrant/Check Number 3010139202

(if known) (6)
Original Date of Issue
| (if known) (7) 30-Dec-2022

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

(1 Payroll
For Services or Goods furnished / BLAKE, TAYLOR RENTAL ASSISTANCE

(a)
[] Treasurer's refund/payment
Other: / check presumed lost / fund : 222 / GAX1D 23*14761

2/16/2023

CHAMBERLIN
ASSOCIATES

Real Estate Management

February 6, 2023

1, 3 Ave GG LLC, authorize Carla Bernal, Administrator/ Property Manager, to execute an
affidavit on behalf of Chamberlin & Associates/ 3" Ave GG LLC

Yours Truly,

Kate Clouse

3'¢ Ave Investments

PAY TO-THE ORDER OF
3RB AVE GG LLC
ATTN Rental Office

124
2-30-2022 atoagt

ED petetts on Back.

c $7,014.15° -

AMOUNT ~ |

Mold After CHAIRMAN
365 Days . y
— i HEE FINANCIAL GPFICER
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*_Securlly Features Included.