STAMPED - PHOENIX QUEEN CREEK 2020 LLC.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson, 9 Floor
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: January 19, 2023
To: Clerk of the Board
From: Marcia J. Bulanda

Office of Budget and Finance

Subject: Affidavit - PHOENIX QUEEN CREEK 2020 LLC

Please find attached 1 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 lost.

Please call me 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: FUND 222 - D220 HUMAN SERVICES — GAX1D 23*9851
LOVETT, CHARVALIA — RENTAL ASSISTANCE

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

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

STATE OF ARIZONA Note: Numbers on this form correspand to

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

PHOENIX QUEEN CREEK 2020 LLC (1) being first sworn, Upon oath deposes and says:
Namé/Ciaimant

On or about 92-Nov-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 of was subsequently inadvertently Jost 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 4,366.53 -(3)
Signed: ( a Ne (4)

Note: Please aitson a copy of the warrant/check if available and/or any other
evidence that'a warrant/check was originally issued.

ite, and sworn to before me this (S day of Dauner 20 Ee

NOTARY PUBLIC

My a7) pois

Wanant/Ghek Number 3010132974

Gé known) (6)

Original Date of Issue
(if known) (7) 02-Nov-2022

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

) Payroll
Ct For Services or Goods furnished

(1 Treasurer’s refund/payment
Other: / original check presumed lost in the mail

FUND 222.-D220 HUMAN SERVIGES - GAX1D 23"9851

LOVETT, CHARVALIA - RENTAL ASSISTANCE 1/20/2023

LUXURY APARTMENTS

825 W. Queen Creek.Rd., Chandler, AZ 85248
Phone.480.699.4610 Fax 480.699.4614
luxeatocotillo@amelic net

1/09/2023

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

Sincerely,

Seléna Rojo
Assistant Manger

COUNTY EXPENSE WeRRANT = TREASURER OF MARICOPA COUNTY WARRANT NUMBER

PHOENIX, ARIZONA 3010132974
DATE
11-02-2022
-2/2!
JPMorgan Chase Bank NLA ot-2nneat
Phoenix, AZ,

R F $4,366.53
PAY TO THE ORDER O

PHOENIX QUEEN CREEK 2020 LLC . AMOUNT
ATTN RENTAL OFFICE Void At

825 W QUEEN GREEK RD Sei one

CHANDLER AZ 85248

For Questions - 602-506-1379 or emuil AP@MAT..MARICOPA.GOV

: ~ NOT NEGOTIABLE

MARICOPA COUNTY DEPARTMENT OF FINANCE i

RETAIN THIS FOR | PAYER WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

YOUR RECORDS

PHOENIX QUEEN CREEK 2020 LLC 3010132974 11/02/2022 $4,366.53

INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO, AMOUNT

INV-0000572135 LOVETT, CHARVALIA - Rental Assistance GAX1D D220 230000009851 1,455.51
230000009851 :

INV-0000572136 LOVETT, CHARVALIA - Rental Assistance GAX1D D220 230000009854 2,911.02 i

230000009851