STAMPED & REDACTED - CHERYL CAMPBELL.PDF

MARICOPA COUNTY
Office of Budget and Finance

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: November 15, 2022
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 Theattached 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 cail me at if you have any questions. Please return the approved
affidavits to my attention in the Office of Budget and Finance.

Thank you.

Re: Fund: 222 / Dept :220 —
Human Services /
Company: CHERYL
CAMPBELL

Application for a Duplicate or Stale-Dated Warrant/ Check
Affidavit/Claim Form

This application is for: Duplicate or [J state-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.
CHERYL CAMPBELL (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 93-Oct-2022 (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 $ 2,700.00 (3)
signed: — OR Ca Peet. (4)

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_/ %* day of plodabar 20) 2.

Tass

NOTARY-POBLIC fren Hela Public. Stab orang
My commission expires: ' Explies Februaty 16, 2023
D~ I fy - 202.2 (seal)
Warrant/Check Number
check Nu 3010129902
Original Date. of Issue 11/16/2022
(ienow) CO 03-Oct-2022 Ee

Reason for original issue of Warrant/Check (8):

Payroll
For Services or Goods furnished /ALTAMIRANO, STEPHANIE - RENTAL ASSISTANCE

QO) Treasurer's refund/payment
fl Other; / check presumed lost / fund : 222 / GAX1D : 23*7186

Cheryl Campbell

To Whom it May Concern,

| own the building that we are renting to Stephanie Altamarin at ,AZ

. fam a sole Proprietor and not an LLC. [have no employees and can only attest for myself. lam
requesting the replacement of check 3010129902 dated October 3, 2022. Since we have not received
the check, Stephanie is now 3 months behind in. rent. | appreciate any assistance you can now give me
to get the rent check.

Cr 2 Ce eb ee

Chery! Campbell

480-201-4181

NOTICE OF APPROVAL/DENIAL/APPEAL HSD

FOR SERVICES

Der Stephanie Altamirano

a Your application, submittsdtakea on 08/26/2022 (date), for the assisfance noted below has been APPROVED.

The following payments will be made on your behalf:

Vendor Name or Type of Assistance Amount
-ERA rent assistance-Sep/2022, Oct/2022 & Nov/2022 $2700.00
-ERA. -APS- $ :
-ERA-SWG 3___ 76.29
-LINEAP-SWG $_._187.00

~-LINEAP-APS $133.00

Please note: Amounts abe snbject 10 change pending Finance approval:

CW our application for has been DENIED,

assistance, iaken on
The reason(s} your application was denied is:

Your household grogs income was over the Program mcome Limits,

You have already been assisted and are not aligible et this time. You MAY be eligible on or after thiz date: on

You requested that your application be withdrawn,

You sté not a resident of Arizona,

‘The program(s) you were applying for has Policy requirements you did uot meet, The specific requirements you did uot
stleef are: :

‘You failed to meet the 5-day deadline provided requesting verification documents needed te coniplete your application
and to deteanine your eligibiliny. You failed ta

provide!
Ch At the ume of your eligibiliny determinatic
LI Your rerideace is aut af Maricopa County

O onnoad

Yaw Were to longer living at the addeass of application,
service areg,

Non-Appealable Denial Reasons:

1. You are not a resident of Arizoria.

2. You failed to meet the S.day deadline provided by your caseworker requesting verification documents needed to assess
eligability,

Atthe time of your eligibility determination, you were no. longer living at the address of application.

Your resideate is out of Maricopa County’s service area,

Be tase

APPEAL INFORMATION

You have a right te Appeal this decision within 10 business days of receipt of the Denial Notice,

if'you applied at your fecal Community Action Program (CAP) Office, please contact their
wiitten Grievance Procedures, Please note: Reasans listed under “Non-Appealable Denial Rear

and request 2 copy of their
ag” are nnappealable

if you applied on-line through the Client Portal with
Community Services at ¢
Usted under“)

aricop2 County, please contact to Norma Peterson at Maricopa County
ad request 3 copy efour Grievance Procedures, Please nate: Reasotis
easona” are unappealable,

Anna 4 thane Gi hein pate isstiep, 08/26/2022

STAFF SIGNATURE:

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