STAMPED & REDACTED - FOR AGENDA ATTACHMENT - WEST USA REALTY INC.PDF
Extracted text (via ocr_local)
2620 characters
v MAR) COPA COUNTY Office of Budget & Finance 301 W. Jefferson St., 9* Floor Phoenix, Arizona 85003 P: 602-506-3561 F: 602-506-4451 Maricopa.gov To: Clerk of the Board From: Office of Budget & Finance, Accounts Payable Date: 3/26/2024 Subject: Affidavit — Replacement of Lost Warrant Please find attached one Affidavit for a 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. e The original warrant is presumed lost. Please call Joyce Maurmann at 506-1343 if you have any questions. Please return the approved Affidavit to my attention in the Office of Budget and Finance, 9" Floor. Thank you. Re: Warrant #3010159469 / WEST USA REALTY INC Fund 222 — D220 GAX1D 240000004464 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 page 2 of this form. WEST USA REALTY INC (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 28-Aug-2023 (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 igsu him/her in the sum of $ 1,892.55 -(3) Signed: b- ~ (4) Note: Please attach a copy of the warrant/check if available and/or any other evidence that a watrant/check was originally issued. (5) Subscribed and sworn to before me this [5th day of March 202t NOTARY PUBLIC My commission expires: [[-23-2 (seal) W. nm Check Numbe i known) (6) i 3010159469 ial (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll For Services or Goods furnished O Treasurer's refund/payment Other; Rental assistance - Wendy Fonseca - Fund 222 D220 GAX1D 24*3394 April 22, 2024 |, _ Duane P Fouts on behalf of West USA Realty Inc. Yours truly, — Duane P Fouts Broker, West USA Realty Inc. TE cottscale, AZ 85260 | maneuamempegmm| westusa.com Broker, authorize Tony Novey, Agent, to execute an affidavit WestUSA REALTY