W DEAN WEIDNER VISIONS ENERGY APARTMENT HOMES1.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

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INTEROFFICE MEMORANDUM B 1°
Date: November 30, 2020 eS e772
o a
To: Clerk of the Board Bw Ome
From: Walter Chang rm 2s
Department of Finance n “2 Q
Subject: Affidavits — Replacement of Lost Warrants ‘ Ww
G.
&

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:220— Human Services / Company : W DEAN WEIDNER VISIONS ENERGY
APARTMENT HOMES

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form

This application is for: Duplicate or C 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.

W DEAN WEIDNER VISIONS ENERGY APARTMENT HOMES (1) being first sworn, upon oath deposes and says:

~~ Name/Claimant

On or about 06-Oct-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

warrant/check be i wee sum of $ 3,000.00 -(3)
Signed: ( ol of Lo (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 swoyn to,before me this 24 day of November 20 Z0.
Wy

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TE KEYERA JOLLEY
OY Notary Public - Arizona
i Maricopa County
issi i - Commission # 587704
My commission expires, LWT” My Comm. Expires Sep 7, 2024
September 7, 2024 (seal)

Warrant/Check Number 13940068827

(if known) (6)

Original Date of Issue
(if known) (7) 06-Oct-2020 WOV_ 3,0 2020

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

01 Payroll !

For Services or Goods furnished_/ COVID rental payments

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

WEIDNER

APARTMENT HOMES

November 24, 2020

1, Daniel Gomez, authorize Adilene Herrera Arias, Leasing Manager, to execute an affidavit on
behalf of W Dean Weidner/ DBA Visions Energy Apartment Homes.

Yours truly,

Daniel Gomez

Community Director

Visions Apartment Homes

13720 N 88" Avenue Peoria, AZ 85381
(623)266-2185