STAMPED & REDACTED - FOR AGENDA ATTACHMENT - SILVERWOOD APARTMENTS TEMPE LLC.PDF

v
MAR) COPA
COUNTY

Office of Budget & Finance To: Clerk of the Board
301 W. Jefferson St, 9*Floor From: Office of Budget & Finance, Accounts Payable
Phoenix, Arizona 85003

Date: 8-23-2024

Subject: Affidavit — Replacement of Lost Warrant
P: 602-506-3561

F: 602-506-4451

Please find attached one Affidavit for a lost warrant to be included on the next
Maricopa.gov available Board Agenda.

* The attached item has been researched to ensure the warrant in question has not
been cashed or previously re-issued.

e The original warrant is presumed lost.

Please call Walter Chang at 506-8747 if you have any questions. Please return the
approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor.

Thank you.

Re: Fund : 296 / D220 - Human Services / vendor name : SILVERWOOD
APARTMENTS TEMPE LLC

Application for a Duplicate or Stale-Dated Warrant/ Check

Affidavit/ Claim Form

This application is for: Duplicate or (J Stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to
COUNTY OF MARICOPA pumbers on tne Instruction sheet which is

SILVERWOOD APARTMENTS TEMPE LLG (1), being first sworn, upon oath deposes and says:
Name/Ctatnant

On or about 11-Jun-2024 (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 the sum of $2,007.00 3)

warrant/check be issue

Signed: MN, Z AY pn (4)

Note: lease attach a copy of the warrant/check if available and/or any other

evidence that a warrant/check was originally issued.

(5) Sbsciba and sworn to before me this _Qrx\ day of Dyoust 20.444.

oO

NOTARY PUBLIC

SHANTEL WRIGHT
Nolary Public - Slate of Arizona
MARICOPA COUNTY
Commission # 853440

My co! Nea sepaes:

HIPC Expires July 20, 2027 (seal)
Warrant/Check Number
Original Date of Issue
(if known) (7) 11-Jun-2024 8/23/24

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

1 Payroll
For Services or Goods furnished / JURADO, HECTOR - RENTAL ASSISTANCE

O  Treasurer’s refund/payment
Other: / check presumed lost / fund ; 296 , initiated by the vendor

—.

SILVERWOOD APARTMENTS

August 20, 2024

To Whom It May Concern,

Please be advised that Neil Sherman, Managing Director of SPERRY-Insignia CRE, our
property management company, is hereby authorized by me to both sign and have notarized
the attached Affidavit/Claim Form pertaining to Hector Jurado, who resides in Apartment
#104 at Silverwood Apartments,

If you have any further questions or concerns, please feel free to call me |
(Cell).

Sincerely,

Stsigy Zychinny 08/20/2024

Susan Zachman

Member

Silverwood Apts Tempe, LLC
EIN# 81-4141752