STAMPED & REDACTED MINORI LLC.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: February 8, 2022
To: Clerk of the Board
From: Nadine Higuera

Department of Finance

Subject: Affidavit — Replacement of lost warrant

Please find attached 1 Affidavit for 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 is stale dated

Please call me at 506-1354 if you have any questions. Please return the approved

Affidavits to my attention in the Department of Finance, Suite 960.

Thank you.

Re: Fund 222 Dept: Human Services Company Minori LLC

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or C1 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.
MINORI LLC (1), being first sworn, upon oath deposes and says:
Name/Claimant
On or about 10-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 of $ 1,125.00 .(3)
Signed: OF : (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_3/°* day of J2near4- 20 ole,

NOTARY PUBLIC
aE MILDRED V PUNLA
% Say Notary Public - Arizona
My commission expires: ee) arcopa County
Tansey Ad, Road SEE” my Comm. Expires Jan 22, 2023 (seal)

a

Ww. t/Check Numb
ave (if ‘nown) (6) er 301 0104812

Original Date of Issue |
(if known) (7) 10-Dec-2021

02/08/2022

Reason for original issue of Warrant/Check (8):
C1 Payroll
0 For Services or Goods furnished

O Treasurer's refund/payment
Other: / Original check presumed lost in the mail

Minori, LLC

Tempe, AZ 85284-3604
Tel:
Fax:

January 31, 2022

J, John Vinson, authorize Millie Annis, Executive Assistant Office Manager, to execute an
affidavit on behalf of Minori, LLC.

Sincerely,
‘ —

John Vinson
President / Manager for
Minori, LLC

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010104812

DATE
12-10-2021 91-2/1221

One Thousand One Hundred Twenty Five And 00/100 Dollars

$1,125.00
PAY TO THE ORDER OF
AMO
MINORI LLC LAMOUNT |
VINSON REALTY GROUP ;
Void After

365 Days

For Questions « or email

MARICOPA COUNTY DEPARTMENT OF FINANCE

NOT NEGOTIABLE

RETAIN TIS FOR | PAYEE WARRANT NO, | WARRANT DATE | WARRANT AMOUNT
YOUR RECORDS
MINORI LLC 3010104812 12/10/2021 $1,125.00
PURCHASE ORDER NO. | VOUCHER NO. AMOUNT

INVOICE NUMBER | DESCRIPTION

INV-0000453445 NEWELL, JENNIFER - RENTAL ASSISTANCE =| GAX1D D220 220000011371 1,125.00

220000011371