STAMPED AND REDACTED - FOR AGENDA ATTACHMENTS - 3010227272 - R & R FAMILY TRUST AFFIDAVIT.PDF

MAR COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9" Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

Maricopa.gav

To: Clerk of the Board

From: — Office of Budget & Finance, Accounts Payable
Date: 01.08.26

Subject: Affidavit — R & R FAMILY TRUST

Please find attached one Affidavit for a Duplicate warrant to be included on the next
available Board Agenda.

* The attached item has been researched to ensure the warrant in question has not
been cashed or previously re-issued.

* The original warrant is presumed lost.

Please call Marcia Anderson 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 296 — D220 HUMAN SERVICES — GAX1D 26*7238 — RODRIGUEZ, DANIEL —
RENTAL ASSISTANCE

tu |
MARICOPA Application for a Duplicate or Stale Dated

COUNTY Warrant/Check Affidavit/Claim Form
This application is for Duplicate or L_|stale-Dated (definitions are on page 2)
STATE OF ARIZONA Note: Numbers on this form correspond te the numbers
COUNTY OF MARICOPA on the Instruction sheet which is page 2 of this form
R&R FAMILY TRUST (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 24-NOV-2025 (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 issues to him/her in the sum of $4,200.00 . (3)

Signed: (4)

Print Name: (reqfted)__Be. eamilif Tlevsr  deserr7 Ruiz

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 . SA2 day of Lewy 202¢.

NOTARY PUBLIC Frye 1. Se ymer or

My commission expires:
Seeivitiy 7 202%

Warrant/Check Number 3010227272

Original Date of Issue
; fifknown) 7) 24-NOV-2025
Reason for original issue of Warrant/Check (8):
C1 Payroll _

(For Services or Goods fumished
1 Treasurer's refund/payment
2 Other, 0220-HUMAN SERVICES-FUND 286- GAX1D 26°7238- RODRIGUEZ, DANIEL - RENTAL ASSISTANCE

SAPROCESSES\Warrants - Duplicate or Stale\02 Forms\Current Claim Form\100518 Warrants Checks notice of claim.doc Revised
100518

ARS. 11-632 & 11-644

R&R Family Trust

Date: December 22, 2025
RE: Authorization to Sign Affidavit for Lost / Never Received Check
To Whom It May Concern,

This letter serves as formal authorization to execute an affidavit on behalf of R&R Family
‘Trust regarding a check that was never received, which was made payable to R&R Family
Trust,

R&R Family Trust hereby authorizes Joseph Anthony Ruiz, whose title/role is an Authorized
Representative, to act ov behalf of the Trust for ali matters related to this issue. R&R Family is
a Sole proprietor ownership with no employces at the moment. This authorization specifically
includes, but is not limited to, the authority to sign any required affidavit, declaration, or
documentation pertaining to the lost or never received check on behalf of the business.

The authorized signer is empowered to communicate with your office, complete required forms,
and take any necessary actions to facilitate the reissuance or resolution of the check matter,

This authorization shall remain in effect unless revoked in writing by R&R Family Trust. If you
require any additional information or verification, please feel free to contact us directly.

Soe Vib ead) Sincerely,

Seep Antbeny Ruiz
Title: CEO / Authorized Representative
R&R Family Trust