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MARICOPA COUNTY Department of Finance 301 West Jefferson, Ste 960 Phoenix, Arizona 85003 INTEROFFICE MEMORANDUM Date: November 9, 2020 To: Clerk of the Board From: Walter Chang Department of Finance 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 Department of Finance, Suite 960. Thank you. Re: Fund: 200 / Dept: D220 - Human Services / Company : DEER VALLEY GARDENS APT nw fas Te 4 ote I) ap <0) UNS Application for a Duplicate or Stale-Dated Warrant/ Check Affidavit/Claim Form This application is for: Duplicate or O stale-Datea (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. DEER VALLEY GARDENS APT (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 21-Sep-2020 (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 to him/her i um of $3,000.00 .3) Signed: cL y Note. Please attach a copy of the warrant/check ff available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this day of 20. SEE ATTACHED CALIFORNIA NOTARY NOTARY PUBLIC My commission expires: (seal) Warrant/Check Number 3010067068 (if known) (6) Original Date of Issue ° (if known) (7) 21-Sep-2020 Reason for original issue of Warrant/Check (8): O Payroll 1 For Services or Goods furnished 1 Treasurer's refund/payment Other: Rental assistance payment A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of CALIFORNIA County of ORANGE Subscribed and sworn to (or affirmed) before me on this 2nd day of November 2020, by Ana Marie del Rio, proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Ax pbb. Notary Public F OMM, NOTARY Mite Cem i) ORANGE County Lee” MY Comm Exp, APR. 10, 2022 i 18100 Von Karman Avenue, Suite 500 ¢ Irvine, CA 92612 ¢ Phone: 949-852-0700 ¢ www.steadfastcompanies.com CERTIFICATE OF INCUMBENCY I am the Chief Executive Office of Steadfast Companies (“Company”) and the beneficial owner of Steadfast LB Deer Valley, L.P., which owns Deer Valley Apartments in Sun City West, AZ (“Property”). I have the power and authority to execute this Certificate on behalf of the Property owner. The individual below is authorized to execute and deliver certain documents on behalf of the Company in connection with the Property and its management, and the signature after the authorized officer's name below is the genuine signature of such individual. NAME TITLE (by, 2 Ana Marie del Rio Chief Legal Officer (Ln turBea Dated: November 2, 2020. STEADFAST LB DEER VALLEY, L.P. By: Rodney F. Emery, CEO Steadfast Companies Proceed With Integrity Value People Embrace Opportunity Pursue Excellence Do Good As We Do Well COUNTY EXPENSE WARRANT = TREASURER OF MARICOPA COUNTY WARRANT NUMBER PHOENIX, ARIZON 3010067068 € Vos W ara’ an fe) 0 DATE 09-21-2020 JPMorgan Chase Bank N.A st-ariaat Phoenix, AZ Three Thousand And 00/100 Dollars YTOTHEOR $3,000.00 PAY TO THE ORDER OF DEER VALLEY GARDENS APT AMOUNT 15051 W DEER VALLEY DR Void After ATTN RENTAL OFFICE 365 Days SUN CITY WEST AZ 85375 For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV NOT NEGOTIABLE MARICOPA COUNTY DEPARTMENT OF FINANCE RETAIN THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT YOUR RECORDS DEER VALLEY GARDENS APT 3010067068 09/21/2020 $3,000.00 INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT 21-112844-09 SHARON MEYER RENTAL ASSISTANCE GAX1D D220 210000004618 3,000.00 210000004618