STAMPED AND REDACTED - 3010229148 - WESTERN IB HUNT GROVES LP.PDF

l
MARlCOPA 
COUNTY 
Application for a Duplicate or Stale Dated 
Warrant/Check Affidavit/Claim Form 
This application Is for lvl Duplicate or D Stale-Dated (definitions are on page 2)
STATE OF ARIZONA 
COUNTY OF MARICOPA 
Note: Numbers on this form correspond to the numbers 
on the Instruction sheet which is page 2 of this form 
WESTERN 18 HUNT GROVES, LP - GROVES APARTMENT (1), being first sworn, upon oath deposes and says: 
Name/Claimant 
On or about 12i16i2D25 
(date) (2) a warrant/check was issued to the above named
person/entity in the amount 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 $ 1, 319.oo
. (3) 
Signed:ʠʡ
(4) 
Print Name: (required) S::\ʢ:r,c-,'l)·,l,, '6:c'l',/1!'\
Note: Please attach a copy of the warrant/check If avallable and/or any other evidence that a 
warrant/check was originally Issued. 
ʣ
e this __fl_ day of Eebc1AW5' 
NOTARY UBLIC 
(i)	(Y'JI) 'W1'l1: F\JENTBSIIAAQ\JEZ 
Noiary Public • Arizona 
My commission expires: 
MARICOPA COUNTY 
Commission # 671785 
Gl!,j 
l I e LOZA
Expires May 16, 2028
Warrant/Check Number 
000003010229148 
(If known) (6) 
Original Date of Issue 
12/16/2025 
(If known) (7) 
Reason for original Issue of Warrant/Check (8): 
20.lli,e. 
(seal) 
□Payroll ________________________ _
□For Services or Goods furnished _________________ _
□Treasurer's refund/payment __________________ _
□Other: __________________________ _
S:\PROCESSES\Warrants-Dupllcate or S\ale\02 Forms\Current Claim Form\ 100518 Warrants Checks notice of claim.doc Revised 
100518 
A.RS. 11-632 & 11-644