STAMPED & REDCATED TREEHOUSE COMMUNITIES PHOENIX EL SAN JUAN.PDF

MARICOPA COUNTY

Office of Budget and Finance
301 West Jefferson

Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM
Date: December 7, 2021 —— oe
RECEIVED-et
To: Clerk of the Board ;
DEC 06 2021
From: Walter Chang MARICO!A COUNTY
Office of Budget and Finance CLERK BOAFiD OF SUPERVISORS

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 506-8747 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: Human Services / Company: TREEHOUSE COMMUNITIES PHOENIX
EL SAN JUAN

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

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

being first sworn, upon oath deposes and says:

TREEHOUSE COMMUNITIES /PHOENIX EL SAN JUAN (1)
é
Name/Claimant

On or about 06-Oct-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, er 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

ee Te nn ;960.00 3)
Signed: : (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__ 2._day of Mavenbe 202.1

NOTARY PUBLIC

Es JASJIT SINGH
ay Notary Public - State of Arizona
MARICOPA COUNTY
> é Commission # 577545
rates Expires February 23, 2024 (seal)

My commission expires:
fet 23,2524

Warrant/Check Number
(if known) (6) 3010099840

Original Date of Issue
(if known) (7) 06-Oct-2021

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

CO Payroll
For Services or Goods furnished / MARIA GARFIO RENTAL ASSISTANCE

Ll Treasurer's refund/payment
Other; / check presumed lost

COMMUNITIES

11/23/2021

To Whom It May Concern:

|, Rudy Mariscal, am the Community Manager for Treehouse Communities at E!
San Juan. | verify that | will be the authorized representative to sign for the
document. For more information please contact me at

Rudy Mariscal

Community Manager