STAMPED & REDACTED HABITAT FOR HUMANITY CENTRAL ARIZONA .PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

Date: June 20, 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: Habitat for Humanity Central Arizona

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
page 2 of this form.

being first sworn, upon oath deposes and says:

Habitat for Humanity Central Arizona (1),
Name/Claimant

On or about 17-Feb-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. in in the “ of $ 1,500.00 (3)

Signed: * uh LL Uicodla (4)

Note: Ploae’ attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

ss

©) Setscrbed and er before me this fl. vies day of |: qi HE 20.2,

NOTARY PUBLIC

Notary Public State of Anzona
Maricopa County

Diane D Sanchez
My Commiseton Expires 10/24/2022
Commission Number 553440

My commission ex expires:
LY LORD,

(seal)

Warrant/Check Number 3010110334

(if known) (6)

Original Date of Issue
8 (if keown) (7) 17-Feb-2022

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

{1 Payroll

For Services or Goods furnished J VITAL, MARTIN 1000066402 - 1000066403 MORTGAGE ASSISTANCE

(1 Treasurer's refund/payment
Other: / check presumed lost / fund : 222

06/20/2022

any Habitat,

Central Arizona

6/15/2022
To whom it may concern,

| Lisa Weide, Chief Program Officer with Habitat for Humanity Central Arizona authorize Maribel
Saucedo, Director of Family Services to sign the Affidavit/Claim form on behalf of Habitat for
Humanity Central Arizona. The form acknowledges that the check in the amount of $1500.00 is
presumed lost.

Should you have any questions, please do not hesitate to contact me at

Sincerely,

Aunty

Lisa Weide

habitatcaz.org * ROC #251891 ROC #324644
Reasonable accommodations will be made upon request. We proudiy work with Arizona Relay Service (TTD) 711 to provide access to the hearing impaired.