W DEAN WEIDNER VISIONS ENERGY APARTMENT HOMES2.PDF

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM - o
Ez
Date: November 30, 2020 = $50
S son
To: Clerk of the Board = Roe
From: Walter Chang Fa 7S
Department of Finance i
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Subject: Affidavits - Replacement of Lost Warrants a
A
ice

Please find attached 1 Affidavits for lost warrants to be included on the next available
Board Agenda.

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 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
pace 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 11-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

warrant/check be issued to him/her in the sum of $ 3,000.00 -(3)

Signed: ol AA (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) Sybscribed and sworn to before me this 24 day of November 2020 .

NOTARY PUBLIC

GER KEYERA JOLLEY

XO) Notary Public - Arizona
issi j . Maricopa County
My commission expires: Bm

Sit” ~My Comm, Expires Sep 7, 2024 (seal)

W. k
ihe carl us 3010066252
Original Date of Issue 11-Sep-2020

(if. known) (7) ~~
V 30 2020
Reason for original issue of Warrant/Check (8): Hb Lf
0 Payroll

For Services or Goods furnished COVID rental payment

O1 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.

WEE nn
aniel Gomez —_

Community Director

Visions Apartment Homes

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

Yours truly,

Maricopa County Department of Finance
Attn: Accounts Payable

301 W Jefferson Street Suite 960
Phoenix , AZ 85003