STAMPED & REDACTED - OHANA VENTURES.PDF
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v 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.gov To: Clerk of the Board From: Office of Budget & Finance, Accounts Payable Date: 1/28/2025 Subject: Affidavit — Replacement of lost warrants Please find attached 1 Affidavit for a lost 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. e The original warrant is presumed lost. Please call Joyce Maurmann at 506-1343 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: Warrant #3010201024/OHANA VENTURES Fund 100 — D220 GAX1D 250000010170 Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/Claim Form This application is for: 4 Duplicate or L] 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. ___OHANA VENTURES. (1), being first sworn, upon oath deposes and says: Name/Claimant On or about __23 Dec, 2024 (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 $ 3291.00 (3) Signed: we? Of | 22 2S 2ARMEEN Meecieesta) 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_ 2 2— day of J. arudy 2025 ; Lamapure Mohan NOTARY PUBLIC ° RAMAPURA A. MOHAN Comm. #2482089 jotary Public: California & My commission expires: Mas 15, 202S San Joaquin County (seal) . Expires Mar 15, 2028 Warrant/Check Number 3010201024 (if known) (6) [notary public o other offcor completing his cortficale verifies only he Wnty of a Original Date of Issue 23 Dec, 2024 [tumsunoon scot creakiirteed Soreness a nae, BB (if known) (7) STATE OF ot ome uaa ml 22409 Reason for original issue of Warrant/Check (8): : analy 5) ae. om belore me. : Payroll ' (Signature of Notary For Services or Goods furnished t 28/25 Treasurer's refund/payment : a A Other: Rental Assistance- Monique Miller ° Ohana Ventures Your Trusted Property Partner January 23, 2024 To whom it may concern, I, Zarmeen Merchant am the CEO/President of Ohana Ventures LLC and I authorize this affidavit. Regards, Son? Zarmeen Merchant MAPURA A. MOHAN ia #2482089 Notary Public: California § San Joaquin County Comm. Expires Mar 15, 2028 CEO/President Ohana Ventures LLC ‘Anotary public or other officer completi this certificate verifies the identity individua. «°« Sgned the documento anes tis tts ene aay te ‘tuthiuiness, accuracy. of validity of that document. rise OF CALIFORNIA. COUNTY OF an Jo Pal bsviibed and sworn to (or affirmed) belore “me en 2}, day of Son _202-9 ty eco (ley <i ne om! Osivié me, (Signature of Notary)