STAMPED & REDACTED MAKAUI GROUP LLC.PDF

BOARD OF Sine Vicoene
MARICOPA COUNTY MARICOPA vr COUNT er 'S ne
€
Office of Budget and Finance pone
301 West Jefferson Street Ste 960 “H/APR-9 PH 1:42 Ppoliuk
,
Phoenix, Arizona 85003
INTEROFFICE MEMORANDUM
Date: April 9, 2021
To: Clerk of the Board
From: Walter Chang
Office of Budget and Finance
Subject: Affidavits — Replacement of Lost Warrants
Please find attached 1 Affidavits for lost warrants to be included on the next available
Board Agenda.
e The attached items have been researched to ensure the warrant in question
have not been cashed or previously re-issued.
e The original warrants have a void/stale date/stop payment done.
Please call me at 506 - 8747 if you have any questions. Please return the approved
Affidavits to my attention in the Office of Budget and Finance Suite 960.
,
Thank you.
Re: Fund: 200 / Dept: Human Services / Company: Makaui Group LLC

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form
This application is for: Duplicate or (J State-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond to
numbers on the Instruction sheet which is
COUNTY OF MARICOPA
page 2 of this form.
Makau . Group LLC (1), being first sworn, upon oath deposes and says:
On or about 12/02/2020 (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 ¢ 3,000.00 (3)
J Ca 4 a pe
Signed: ty Lio— (4)
GLokoz7ze 7. keo0 AnD 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 __3| SE day of _ Marck 20e\_.
hou
NOTARY PUBLIC ~“= |
NISHA RANI SINGH {
at COMM. # 2248049 a
nage NOTARY PUBLIC*CALIFORNIA >
My commission expires: ALAMEDA COUNTY ”
67~292—A27_ My Commission Expires ( (seal)
JULY 22,2022
|
Warrant/Check
5	1	38	1	1	2	691	2221	165	40	96.417221	Number
5	1	38	1	1	3	1219	2203	77	1	12.596664	ye
4	1	38	1	2	0	415	2239	885	94	-1	
5	1	38	1	2	1	415	2278	148	55	46.070633	__{if
5	1	38	1	2	2	572	2278	116	33	86.003021	known)
5	1	38	1	2	3	700	2277	46	34	96.028748	(6)
5	1	38	1	2	4	943	2239	357	52	93.706177	3010075769
4	1	38	1	3	0	364	2319	1786	105	-1	
5	1	38	1	3	1	364	2319	154	105	90.501785	Original
5	1	38	1	3	2	543	2319	89	105	89.001137	Date
5	1	38	1	3	3	648	2323	45	90	94.292931	of
5	1	38	1	3	4	700	2325	118	88	86.894669	Issue
5	1	38	1	3	5	945	2333	326	55	69.490334	42/02/2020
5	1	38	1	3	6	1623	2403	3	2	75.188049	|
5	1	38	1	3	7	1877	2352	273	38	47.060333	94/09/2021
2	1	39	0	0	0	341	2407	1125	13	-1	
3	1	39	1	0	0	341	2407	1125	13	-1	
4	1	39	1	1	0	341	2407	1125	13	-1	
5	1	39	1	1	1	341	2407	1125	13	95.000000	 
2	1	40	0	0	0	624	2407	842	12	-1	
3	1	40	1	0	0	624	2407	842	12	-1	
4	1	40	1	1	0	624	2407	842	12	-1	
5	1	40	1	1	1	624	2407	842	12	95.000000	 
2	1	41	0	0	0	366	2479	1415	226	-1	
3	1	41	1	0	0	366	2479	1415	226	-1	
4	1	41	1	1	0	366	2479	977	55	-1	
5	1	41	1	1	1	366	2488	149	38	96.722885	Reason
5	1	41	1	1	2	529	2485	61	40	96.933647	for
5	1	41	1	1	3	605	2484	149	50	96.898018	original
5	1	41	1	1	4	772	2485	103	38	96.003273	issue
5	1	41	1	1	5	890	2482	42	40	93.258888	of
5	1	41	1	1	6	944	2479	311	50	92.943993	Warrant/Check
5	1	41	1	1	7	1270	2479	73	51	96.423492	(8):
4	1	41	1	2	0	439	2578	204	51	-1	
5	1	41	1	2	1	439	2583	35	36	78.458389	O
5	1	41	1	2	2	507	2578	136	51	94.010048	Payroll
4	1	41	1	3	0	507	2642	1274	63	-1	
5	1	41	1	3	1	507	2667	68	38	96.026970	For
5	1	41	1	3	2	589	2666	170	39	95.740250	Services
5	1	41	1	3	3	775	2675	42	28	96.121841	or
5	1	41	1	3	4	831	2662	129	41	93.273422	Goods
5	1	41	1	3	5	974	2644	233	58	89.707481	furnished_/
5	1	41	1	3	6	1223	2643	164	42	92.794632	COVID
5	1	41	1	3	7	1406	2642	129	42	96.919983	rental
5	1	41	1	3	8	1554	2642	227	51	96.535576	payments
2	1	42	0	0	0	439	2748	752	129	-1	
3	1	42	1	0	0	438	2748	753	130	-1	
4	1	42	1	1	0	439	2748	649	51	-1	
5	1	42	1	1	1	439	2755	37	37	64.690559	O
5	1	42	1	1	2	504	2749	236	42	55.279270	Treasurer's
5	1	42	1	1	3	755	2748	333	51	90.827507	refund/payment
4	1	42	1	2	0	506	2815	685	62	-1	
5	1	42	1	2	1	506	2837	132	40	89.548256	Other:
5	1	42	1	2	2	678	2818	15	40	89.548256	/
5	1	42	1	2	3	710	2818	136	42	96.288216	check
5	1	42	1	2	4	863	2815	231	54	96.383537	presumed
5	1	42	1	2	5	1113	2815	78	42	96.492203	lost
2	1	43	0	0	0	1168	2695	926	12	-1	
3	1	43	1	0	0	1168	2695	926	12	-1	
4	1	43	1	1	0	1168	2695	926	12	-1	
5	1	43	1	1	1	1168	2695	926	12	95.000000	 
2	1	44	0	0	0	1101	2782	1003	12	-1	
3	1	44	1	0	0	1101	2782	1003	12	-1	
4	1	44	1	1	0	1101	2782	1003	12	-1	
5	1	44	1	1	1	1101	2782	1003	12	95.000000	 
2	1	45	0	0	0	657	2868	1465	15	-1	
3	1	45	1	0	0	657	2868	1465	15	-1	
4	1	45	1	1	0	657	2868	1465	15	-1	
5	1	45	1	1	1	657	2868	1465	15	95.000000	 
2	1	46	0	0	0	2242	1711	17	493	-1	
3	1	46	1	0	0	2242	1711	17	493	-1	
4	1	46	1	1	0	2242	1711	17	493	-1	
5	1	46	1	1	1	2242	1711	17	493	95.000000	 
2	1	47	0	0	0	2531	10	19	3277	-1	
3	1	47	1	0	0	2531	10	19	3277	-1	
4	1	47	1	1	0	2531	10	19	3277	-1	
5	1	47	1	1	1	2531	10	19	3277	95.000000

|
Makaui
To: Maricopa County Department of Finance
Attn: Accounts Payable
From: Jon Woodyard
Date: 3/2/2021
Re: Affidavit signer authorization
|, Jon Woodyard, President Makaui Group LLC, do authorize Georgette Woodyard,
employee of Makaui Group LLC, to execute an affidavit on behalf of Makaui Group LLC.
Please reissue check and mail to
Best regards,
A notary public or other officer
this certificate verifies completing
only the identity of
the individual who signed the -locument to
Jon T. Woodyard which this certificate ig
attached, and not
j_ the truthfulness
Makaui LLC accuracy, or validity of that
President, Group document.
C: (650)
State of California
E: County of Alameda
Subscribed and sworn to (or affirmed) before
me on this_3.)__ day of Maych 20.2)
by on. T_ woo gf Yared 2
perso own to me or proved to me on
the basis of satisfactory evidence to be the
NISHA person (s) who appeared before
RANI SINGH |
es COMM. # 2248049 ™)
£5 \q)5) NOTARY PUBLIC> CALIFORNIA 5 A
ALAMEDACOUNTY Signature of Notary
My Commission Expires
JULY 22,2022
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