STAMPED & REDACTED A PLUS MANAGEMENT II LLC.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: August 22, 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 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 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: A PLUS
MANAGEMENT II LLC

epg () 4,

ae

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

~ This application is for: Duplicate or CI 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
pace 2 of this form.

A PLUS MANAGEMENT II LLC (Dy being first sworn, upon oath deposes and says:

Nameé/Claimant

On or about 31-Jan-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, gr 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 $ 1,702.13 (3)

Signed: yan /h a (4)

Note. Please attach a Soy 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___ ti» _day of Av, wh 20.90_.

NTARY Y PUBLIC ou
4 TENDS BRAD POLLACK
H os Soh Notary Public - Arizona
My commission expires: ef ae evopa County
aS % ee) Commission # 597404

SvKE9S TSE” My Comm. Expires Mar 18, 2025 f (seal)

Warrant/Check Numi
arrant/Check Number 1304()408775

Original Date of I
nigina (it iroun) Oo 31-Jan-2022 : 08/23/2022
* Reason for original issue of Warrant/Check (8): A UGKLI d L4 t' H
C1 Payroll ‘ j

For Services or Goods furnished / WELLS, ANGELICA - RENTAL ASSISTANCE

C Treasurer's refund/payment
Other. / check presumed lost / fund : 222

~
A PLUS MANAGEMENT LLC

August 16, 2022

I, Jason A Wang, is the sole person working for A Plus Management II
LLC.

Yours truly,

A .

Jason A Wang
Owner