SIGNED YELIAB II LLC DBA SUNCREST II MOBILE HOME PARK FOR 021021 AGENDA.PDF

MARICOPA COUNTY “MARICOPA Coun
Office of Budget and Finance
301 West Jefferson Street Ste 960°! JAN 4 AMI: 17
,
Phoenix, Arizona 85003 — Wath Ww
INTEROFFICE MEMORANDUM
Date: January 4, 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 Department of Finance, Suite 960.
Thank you.
Re: Fund:200 / Dept :220-Human Services / Company : YELIAB I] LLC DBA SUNCREST II
MOBILE HOME PARK 3010070319

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form
This application is for: Duplicate or CJ 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
page 2 of this form.
YELIAB 11 LLC DBA : SUNCREST !] MOBILE HOME PARK (1) being first sworn, upon oath deposes and says:
i
Name/Claimant
On or about 19-Oct-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 ¢ 6,000.00 (3)
oe,
C.. 2A —
Signed: (4)
NA
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 AGT day of Tetemder. 2020.
Nirny
Eats
NOTARY PPBLIC
CAROLYN DAY
Notary Public ~ Arizona
@ Maricopa County
My Nor expires: Pp J 4) My Comm. Expires May 17, 2021
ta
Wa 17, ZOZD"
Warrant/Check Number 3010070319
(if known) (6)
Original Date of Issue
19-Oct-2020 01/11/2021
(if known) (7)
Reason for original issue of Warrant/Check (8):
C1 Payroll
/ COVID rental payments
eS For Services or Goods furnishe q
O Treasurer’s refund/payment
/ Original check presumed lost
[x] Other:

Yeliab Il, L.L.C.
Mason T. Bailey
Manager
December 28, 2020
I, Nicholas Gaynor, Authorize Jean Heyer, Manager, to execute an affidavit on behalf of Yeliab II, L.L.C.
Dba Suncrest I] Mobile Home Park.
Yours truly,
me
Coa
Nicholas Gaynor
General Manager

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