REDACTED - FOR AGENDA ATTACHMENT - KOTA NORTH SCOTTSDALE - 3010125542.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: 04.04.24

Subject: Affidavit — KOTA NORTH SCOTTSDALE

Please find attached one Affidavit for a stale 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 23*4369 - 08.19.22 SPUS8 Dakota LP -
Uiility Assistance

Application for a Duplicate or Stale-Dated Warrant/Check 25
Affidavit/ Claim Form

This application is for: OO Duplicate or 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.

KOTA NORTH SCOTTSDALE (1), being first sworn, upon oath deposes and says:

Name/Claimant

On or about 26-Aug-2022 (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, er 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 $ 356.03 3)
Signed: z aa FL. ee a (4)
a

Note» Please_atiach 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 He _day of Apert. 202 if
i f

/ ail a

NOTARY PUBLIC =

VEDA M, GUILLOBY
Notary Public Arizona

My commission expires: 08/2 8/2024

guat 28, 2025 | (Seal)

Warrant/Check Number
(if known) (6) 3010125542

iginal Date of 1

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

{1 For Services or Goods furnished

ma

Treasurer’s refund/payment
Other: Fund 222- D220 HUMAN SERVICES - GAX1D 23°4389 - 08.18.22 SPUS8 DAKOTA LP - UTILITY ASSISTANCE

&

4/3/2024
To whom this may coricern,

This letter is to authorize Megan Joseph approval to sign notary documentation for previous stale checks.
Previous stale checks were issued to Matthew Copelin. Additional information provided upon request.

Best Regards,
Kota North Scottsdale

Property Manager

Sunshine Ellis

counrvexeensewasrast — TREASURER OF MARICOPA COUNTY

PHOENIX, ARIZONA

Three Hundred Fifty Six And 03/100 Dollars

PAY TO THE ORDER OF
KOTA NORTH SCOTTSDALE

" . ~ / OFFICE

For Questions - 602-506-1379 or email AP@MALL.MARICOPA.GOV
MARICOPA COUNTY DEPARTMENT OF FINANCE

DATE
08-26-2022

WARRANT NUMBER

3010125542

94-2/1221

Void After
365 Days

$356,03

AMOUNT

NOT NEGOTIABLE

RETAIN TITS FOR | PAYEE
YOUR RECORDS

WARRANT NO. | WARRANT DATE

WARRANT AMOUNT

KOTA NORTH SCOTTSDALE | 3010125542 08/26/2022 $356.03

INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT

INV-0000552924  /08.19.22 SPUS8 Dakota LP - Utility Assistance |GAX1D D220 230000004269 356.03
230000004369

STALE DATEY

PU

Oo Agency Status Warrant number — [ssued date Paid date Amount
+ [3010125542 | . ” .
Stale 3010125542 2022. 1200:00am__ 8/31/20...

Warrant number, 3010125342

Amount Payee Account

256.92 | SPUS8 DAKOTALP P|

a