STAMPED & REDACTED - PHOENIX QUEEN CREEK 2020 LLC.PDF

MARYCOPA
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: 2.28.23

Subject: Affidavit — Phoenix Queen Creek 2020 LLC

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.

e The original warrant is presumed lost.

Please call Marcia Bulanda 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- Lovett, Charvalia ~ Rental Assistance - D220 - GAX1D 23*9851

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

This application is for: Duplicate or 1 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.
PHOENIX QUEEN CREEK 2020 LLC (1), heing first sworn, Upon oath deposes and says:
Nameé/Claimant

On or about 20-Jan-2023 (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, ar 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 ¢ 4,366.53 2G)

Signed: QC ON (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_7 7-//._day of Hebrunts 2023.

Jak Pas lien

NOTARY PUBLIC = ¢

JAAHIN PAYDAR
Notary Public ~Arizona
Maricopa County

My commission expires: Commission # 634831

Aunt othe 29k My Comm: Expires Aug 10; 2026-Po—-¢aessspy
Warrant/Check Number
(if known) (6) 301 0140904
Original Date of Issue
(if known) (7) 20-Jan-2023
Reason for original issue of Warrant/Check (8): 2/28/2023

O Payroll
O For Services or Goods furnished

1 Treasurer's refund/payment
Other: LOST WARRANT - LOVETT, CHARVALIA - 0220 - FUND 222 - GAX1D 23*9851

LUXE

LUXURY APARTMENTS

, Chandler, AZ 85248
Phone. Fax

2|22| 2623

|, Selena Rojo, authorize Caroline Ingram, Property Manager, to execute an affidavit on behalf
of Luxe at Ocotillo.

Sincerely,

Selena Rojo
Assistant Manger

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER

é PHOENIX, ARIZONA 3010140904
RICO
[hie
( Bas on 02023 1-2/1224
: ESE > ~S0- UES 941-:
Sey

CoG <oy
Four Thousand Three Hundred Sixty Six And 53/100 Dollars

$4,366.53
PAY TO THE ORDER OF
PHOENIX QUEEN CREEK 2020 LLC AMOUNT
ATTN RENTAL OFFICE ;
Void Afier
365 Days

For Questions or ema’ NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMEN1] OF
RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
PHOENIX QUEEN CREEK 2020 LLC 3010140904 01/20/2023 $4,366.53
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
INV-0000572135 LOVETT, CHARVALIA - Rental Assistance GAX1D D220 230000009851 1,455.54
230000009851
INV-0000572136 LOVETT, CHARVALIA - Rental Assistance GAX1D D220 230000009851 2,911.02

230000009851