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Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/claim Form Thisapplication is for: H Duplicate or I stale-Dated (definitionsareon page 2) STATE OF ARIZONA COUNTY OF MARICOPA a DAWGZ LLC On or about 18-Aug-2021 Note: Numbers on this form correspond to numbers on the Instruction Sheet which is paae 2 of this form. (1), being first sworn, upon oath deposes and says: (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, g± 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 NIlhe: P/ease attach a copy of the warrant/check if availab/e and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this 8Y` day of sc4he~ber 2o~\ ff;d- ys- I, I. . . Zi- I Myocamom8ls/Sioonze:~Pires: -©Ow#'tofu##§M:IREztryCowhesienEitplro®Fobrua_8,2025 (seal) Warrant/Check Number if known 3010096202 Original Date of Issue if known 18-Aug-2021 Reason for original issue of Warrant/Check (8): I Payroll E For Services or Goods furnished / MICHAEL SUMLER RENTAL ASSISTANCE I Treasurer's refund/payment E other: / Original Check Presumed lost in the mail / fund : 222 iii- - ; ,` .':- Sep 8, 2021 To Whom it may Concern: lt is hereby authorked by ownership and management of 8 DAWGZ, LLC for Reaaie Williams to sign for duplicate claim form for warrant number, 10096202 for the payment of Rental Assistance for Michael Sumler . This payment has not been remitted and is past due. Thank you for your consideration of the urgency of this matter. This payment should be addressed and dispersed to 8 DAWGZ, LLC and reflect the account settings of the Maricopa County Vendor Identification number, VS0000006070. As of today, EFT payments have been approved and are the preferred method of remittance for all transactions regarding this account. Regards, a DAWGZ, LLC