STAMPED & REDACTED THE FLATS AT PEORIA.PDF
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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. THE FLATS AT PEORIA (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 29-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 warrant/check/be issued to him/her in the sum 8,757.80 (3) Signed: noe KE Le: (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. vers } (5) Subscribed and wi) me this _C WW day of WAX. 20.987 a NOTARY PUBLIC =~ ALEKUS GILLEGPIE F Notary Public - Arizona =) Maricopa Co. | #607088 My commission expires: xpires 06/15/2026 Qh 1S loazs _ Expires (seal) Warrant/Check Number /Check Nu 3010106383 Original Date of Issue 03/15/2022 Reason for original issue of Warrant/Check (8): ) Payroll (2 For Services or Goods furnished ( Treasurer’s refund/payment Other: / original check presumed lost in the mail Fund 296 GAX1D 22*12712 Dept D220 THE SFLATS AT PEORIA 3/14/2022 Maricopa County Office of Budget and Finance Phoenix, AZ RE: Claim for re-issuance of a lost or stale-dated check (warrant) To whom it may concern, Please accept Cinthia Neal as an authorized signer to execute an affidavit on behalf of The Flats at Peoria. Sincerely, Prancly Kamery Brandy Ramsey | Investment Portfolio Manager GRE MANAGEMENT | | COUNTY EXPENSE WARRANT AMILONA cone TREASURER OF MARICOPA COUNTY PHOENIX, ARIZONA DATE 12-29-2021 Eight Thousand Seven Hundred Fifty Seven And 80/100 Dollars PAY TO THE ORDER OF THE FLATS AT PEORIA ATTN RENTAL OFFICE For Questions - 602- D oremail AP MARICOPA COUNTY DEPARTMENT OF FINANCE Void After 365 Days WARRANT NUMBER 3010106383 91-2/4221 $8,757.80 AMOUNT NOT NEGOTIABLE RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS THE FLATS AT PEORIA 3010106383 12/29/2021 $8,757.80 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT INV-0000458809 MILLER, ALEXIS - RENTAL ASSISTANCE GAX1D D220 220000012712 3,026.60 220000012712 220000012712 5,731.20 INV-0000458809 RUCKSJOHNSON, EBONY - RENTAL ASSISTAN | GAX1D D220 220000012712