STAMPED & REDACTED PROGRESS RESIDENTIAL BORROWER 6 LLC.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson, 9 Floor
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: May 72, 2022
To: Clerk of the Board
From: Joyce Maurmann

Department of Finance

Subject: Affidavit — Replacement of lost warrant

Please find attached 1 Affidavit for a lost warrant 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 warrant was lost and not received by vendor

Please call me at 506-1343 if you have any questions. Please return the approved

Affidavits to my attention in the Office of Budget and Finance, 9° Floor.

Thank you.

Re: PROGRESS RESIDENTIAL BORROWER 6 LLC
D220 GAX1D 22*11925 FUND 296

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

This application is for: Duplicate or C 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.

being first sworn, upon oath deposes and says:

PROGRESS RESIDENTIAL BORROWER 6 LLC (4)
Name/Claimant ’

On or about 20-Dec-2021 (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

a
warrant/che "9 issued to oe sum of $2,984.24 (3)

i i 4
Signed: ——y (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 swom to before me this __ {> day of a 20 “2-2

pie wn i

(/ NOTARY PUBLIC <<.

My commission expires:

(seal)
Warrant/Check Number
(if known) (6) 3010105539
Original Date of Issue
9 (if known) (7) 20-Dec-2021 05/17/2022

Reason for original issue of Warrant/Check (8):
O1 Payroll
For Services or Goods furnished Rental Assistance

O Treasurer’s refund/payment
Other: ORIGINAL CHECK PRESUMED LOST IN TRANSIT