LOTUS REAL ESTATE LLC_REDACTED.PDF

Date:
To:

From:

Subject:

MARICOPA COUNTY
Department of Finance

301 West Jefferson, Ste 960
Phoenix, Arizona 85003

INTEROFFICE MEMORANDUM

August 11, 2020

RECEIVED...

Clerk of the Board

dD

AUG 11 29 Cy,
Beth Brown MARICOp 20 D3
Department of Finance CLERK BOARD oF SoUNTY
VISORS

Affidavit - Replacement of Lost Warrant

Please find attached affidavit for lost warrant to be included on the next available Board

Agenda.

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

The original warrant has a void/stale date/stop payment done.

Please call me at 506-1329 if you have any questions. Please return the approved

Affidavit to my attention in the Department of Finance, Suite 960.

Thank you.

Re: LOTUS REAL ESTATE LLC

Fund 222
Dept. 220

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

This application is for: Duplicate or CO 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.

LOTUS REAL ESTATE LLC (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 97-Jan-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 $. 1,464.00 .(3)

Signed: Nowy (al (4)

Note, ‘phase attach a copy of the warrant/check if available and/or any other
evidence that a warrant/check was originally issued.

(5) Subscribed’a orn to before me this _O-¥h_day of Burge 20_20

NOTARY PUBLIC”
My commission expires: MARICOPA CO!
} ) ‘} S ee? Expires ron 57987 (seal)
Warrant/Check ‘Number
(if known) (6) 3010061336 ee
Original Date of Issue |. DATE Y
(iF known) (7) 07-Jan-2020 | A,

Teva —

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

O Payroll
1 For Services or Goods furnished

O Treasurer's refund/payment
Other: Human Services rental assistance payment

Lotus Real Estate, LLC

232 N Chippewa Pl, Suite # 2, Chandler, AZ 85224
Office: 602-773-1259 fax: 480-240-4178

08/05/2020

|, Venkata R Narla, is Sole Proprietor of Lotus Real Estate and | am authorized to execute an affidavit on
behalf of Lotus Real Estate LLC.

Yours truly,

Venkata R Narla

President

Venkata Ramana Narla, Designated Broker

Po vnarla@lotusrealestateus.com