STAMPED & REDACTED - CAL-AM PROPERTIES INC.PDF

MARICOPA
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: 04.02.24

Subject: Affidavit — CAL-AM PROPERTIES INC

Please find attached one Affidavit for a duplicate dated warrant to be included on the
next available Board Agenda.

e 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 Marcia Bulanda at 506-7291 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: Fund 222 — D220 Human Services - GAX1D 24*3833 - PELTON, BONNIE - RENTAL
ASSISTANCE

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Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/ Claim Form

This application is for: Duplicate or C) State-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.

CAL-AM PROPERTIES INC

NETRSICISIREE (1), being first sworn, upon oath deposes and says:

On or about 05-Sep-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
ne 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/chéck ba issued to him/her in the sum of $ 1,603.08 (3)
Signed: Ke fr Vit te ef (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 sworn to before me this Is} day of tebruary 202

aii Go
NQWARY PUBLI Gut tsa at 4

Notary Pubilc State of Arizona
Maricopa County

My_ commission expires: anean Castell!
GnIS-ale camer aR" (seal
Warrant/Check Number
‘noun to 3010159881

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

O Payroll

O1 For Services or Goods furnished

4/02/24

O Treasurer's refund/payment
Other: Rental assistance - Bonnie Pelton

Rose
AK arden

ACTIVE 53° COMMUNITY

March 24, 2024

To: Maricopa County Office of Budget and Finance
301 W. Jefferson Street, 9" Floor
Phoenix, AZ85003

Atin: Accounts Payable
I Janean Castelli, authorize Pam Lawrence, Assistant Community Manager, to execute an
affidavit on behalf of Rose Garden.

Please make check payable to Rose Garden and note on the check that it is for Bonnie Pelton,
Lot 45, so it can be properly posted to the correct account.

Also, please mail the check to:

Cal-Am _

Should you elect to mail it to our Rose Garden office, we can mail it to our office in Texas for
you.

Sincerely, VA, a
WMA Ak Loa tC
‘.”Janean Castelli
Community Manager

OF:

“FY issuecl warrants (Unsayed fiter} ~

‘C1 Agency Status Warrant number — Issued date Paid date Amount
3010159881 «9/5/2023 1200:00 am ; 1,603.08

Warrant humiber, 3070199231

Amount Payee Account

| {BORIS CALA PROPERTIES INC a