STAMPED & REDACTED - MDL PROPERTIES LLC.PDF

MAR)COPA
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: 2-23-2023

Subject: Affidavit — Replacement of Lost Warrant

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

« 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 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 / MDL PROPERTIES LLC

f

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 numbers on the Instruction sheet which is
page 2 of this form.

MDL PROPERTIES LLC (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 05-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 amount shown is due and owing, and the applicant requests that a replacement

warrant/check be issued to him/her in the sum of $2,220.98 -(3)

Signed: fh hers , Mattel (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) SubscifBed and sworn to wan methis (2% day of Febeune/ 2023.
t

NOTARY PUBLIC

My commission expires: x fs Commission sarge

u/t 5/2025 & My Comm, Exoires Nov 15. 2025 fp (seal)

SONIA LONG
Notary Public - Arizona

Warrant/Check Number 301 0136218

(if known) (6)

Original Date of Issue
(ramon Ge 05-Dec-2022 2/24/2903

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

Payroll
© For Services or Goods furnished_/ ARCE, MARITZA - RENTAL ASSISTANCE

O Treasurer's refund/payment
fl Other: / check presumed lost / fund : 222 / GAX1D 23*12225

MANAGEMENT, LLC

2/17/2023

To Whom It May Concem:
RE: Arce, Maritza - Rental Assistance - Authorization Letter

This letter is to inform you that | Leslie Ray authorized Kikey Nunez to execute the
Application for Duplicate Check and Affidavit/Claim Form in the rental assistance case for our
tenant Maritza Arce of site #14 at Mesa AZ 85207.

Should you have any questions please do not hesitate to contact me at 520-888-3219.

Kind regards,

4 12,

Leslie Ray, Own er
MDL Properties LLC

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