STAMPED & REDACTED AMARGOSA PALMDALE INVESTMENTS LLC.PDF

MARICOPA COUNTY? ;: 0 OF SUPER visoR's
Finance. RICU? a
Department of
A605
301 West Jefferson, $s AH I: 50
Phoenix, Arizona 85003 Headl Der: HE
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INTEROFFICE MEMORANDUM
Date: April 15, 2021
1202
To: Clerk of the Board
Ud¥
From: Beth Brown S]
Department of Finance
OS=1IWY
Subject: Affidavit — Replacement of Lost Warrant
Please find attached affidavit for 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 has a void/stale date/stop payment done.
Please call me at 506-1329 if you have any questions. Please return the approved
Affidavit to my attention in the Department of Finance, Suite 960.
Thank you.
Re: AMARGOSA PALMDALE INVESTMENTS, LLC
Fund 200
Dept 210

Application for a Duplicate or Stale-Dated Warrant/Check
Affidavit/Claim Form
This application is for: Duplicate or C) stale-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
paae 2 of this form.
AMARGOSA PALMDALE INVESTMENTS, LLC
(1) being first sworn, upon oath deposes and says:
Name/Claimant
On or about 14-Dec-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/ehegk be is wh/her in the sum of ¢ 4,085.48 .(3)
Notet Please attach of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.
=
ibed and sworn to before me this
|
NOTARY PUBLIC
My commission
_— EE A TOACKED
—
Warrant/Check Number
3010077111
aheck Ne
Original Date of Issue
14-Dec-2020
Dae ote
Reason for original issue of Warrant/Check (8):
04/16/2021
CO Payroll
C1 For Services or Goods furnished
QO) Treasurer’s refund/payment
Other: Utilities-SRP-Southern Plaza

CALIFORNIA JURAT WITH AFFIANT SL ATSRENT SOVERNMENT Eero $ 8202
aes APS Bocument-Signer-Ne—t- 7 GAL ; ;
Signature-of —Signaiure-of Document Signer No? (if any) a»
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California Subscribed and sworn to (or affirmed) before me
County of ANGELES LoS
un"y on this_ ‘774 gay or Aric _, 20205,
Date Month Year
by
MES A. Gis ®0eCr
(1)
(and (2) )s
Name] of Signer(s¥
proved to me on the basis of satisfactory evidence
MARIKAN A. REINKE
Notary Public - California to be the pergon(f who appeared pefore me.
Los Angeles County .
Commission # 2283247
My Comm. Expires Apr 24, 2023
Signature
Signature of Notary Public
Seal
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document Date:
Number of Sanerts) Other Than Named Above:
Pages:
I < w
©2014 National Notary Association « * NationalNotary, org: -800- -US NOTARY (t- 800-
5	1	38	1	1	18	1755	2910	72	66	29.152250	B76-
5	1	38	1	1	19	1815	2907	101	76	20.808992	6827)
5	1	38	1	1	20	1964	2915	57	61	73.364822	item
5	1	38	1	1	21	2041	2911	17	5	51.286041	#
5	1	38	1	1	22	2044	2910	98	67	85.612480	#5910
www. 1

Office Address:
— 7 7 Beverly Hills, CA 90210
The Bilak Companies
Tel
Fax:
Real Estate Management, Acquisitions & Development
April 8, 2021
To Whom It May Concern,
Amargosa Palmdale Investments, LLC is the owner of the Southern Plaza Shopping Center.
|, Dorian Bilak, Manager and President, authorize Mr. James A. Ginsburg, Vice President, to execute an
affidavit on behalf of Amargosa Palmdale Investments, LLC.
Thank You,
—
Can
itn
Manager & President
Amargosa Palmdale Investments, LLC
The Bilak Companies