REDACTED - FOR AGENDA ATTACHMENT - KOTA NORTH SCOTTSDALE - 3010133775.PDF

ANE

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*10439 - Copelin, Matthew - Rental
Assistance

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

This application is for: [1 Duplicate or [I State-Dated (definitions are on page 2)

STATE OF ARIZONA Note; Numbers on this form correspond to

COUNTY OF MARICOPA numbers on ihe Instruction sheet which Is.
pace 2 of this form.

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

Name/Claimant

On or about 99-Nov-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, ar 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 $478.37 8)
—_
“ —
Signed: — — - *L4 yO (4)
<f wa -

Note: pleake attach @ copy of the warrant/check if available and/or any other
eviderice” that a wartant/check was originally issued.

afbh ; >
(5) Subscribed and sworn to before me this__*7'" _day of 4 pet 202 f .
i/ anf be AG
Vedat f M

NOTARY PUBLIC

My commission expires: s2/:

iB BVT
£28, 202s eal)

Warrant/Check Number | 3949133775

(if known) (S) i

Original Date of Issue 09-Nov-2022

Reason for original issue of Warrant/Check (8):
Ci Payroll
(0 For Services or Goods furnished

C) Treasurer’s refund/payment _
@ Other: Fund 222- D220 HUMAN SERVICES - GAX1D 23°1043@ - COPELIN, MATTHEW - RENTAL 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 Narth Scottsdale

Property Manager

Suhin PLD
Sunshine Ettis

COUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
PHOENIX, ARIZONA 3010133775

DATE
11-09-2022 94-2/1221

Four Hundred Seventy Eight And 37/100 Dollars

$478.37
PAY TO THE ORDER OF
AMOUNT
KOTA NORTH SCOTTSDALE
ATTN RENTAL OFFICE , ;
Void Affer
For Questions - 602-51 479 or email AP@MAITL MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN ‘THIS FOR | PAYEE WARRANT NO. | WARRANT DATE | WARRANT AMOUNT |
YOUR RECORDS — 1
KOTA NORTH SCOTTSDALE | 3010133775 11/09/2022 $478.37
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
INV-0000574719 _ |Copelin, Matthew - Rental Assistance GAX1D D220 230000010439 478.37,

230000010439

EP - coe
"| “® Al warrants (Unsaved filter} °
oO Agency Status Warrant number — Issued date Paid date Ameunt
Stale wee 3010133779. 11/9/2022 e000 am 11/302... 478,37)

Werrant number 3010132

ATS.37 SPUS8 DAKOTA LP

3
Amount . Payee a