STAMPED & REDACTED - FOR AGENDA ATTACHMENT - JLVIV LLC - VIVIENDAS SCOTTSDALE APARTMENTS.PDF

ee

MAR ' COPA
COUNTY

Office of Budget & Finance To: Clerk of the Board
301 W. Jefferson St, 9" Floor

From: Office of Budget & Finance, Accounts Payable
Phoenix, Arizona 85003

Date: 03.12.24

Subject: Affidavit — JLVIV LLV - Viviendas Scottsdale Apartments
P: 602-506-3561

F: 602-506-4451

Please find attached one Affidavit for a duplicate warrant to be included on the next
Maricopa.gov 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*2530 - Maria Morales Sotelo — Rental
Assistance

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

This application is for: Duplicate or LC] Stale-Dated (definitions are on page 2)

STATE OF ARIZONA Note: Numbers on this form correspond to

COUNTY OF MARICOPA Det lg leh
oo - Viviendas Scottsdale Apartments (1) being first sworn, upon oath deposes and says:
On or about 17-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, daimant hereby affirms that this claim is correct
and the amount shown is due and owing, and the applicant requests that a replacement

warrant/check b¢ issued to him/her in the sum of ¢ 3,000.00 .(3)

Signed: ms (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 __7/ il day of ke byuorg 20.24.

(Nu.

NOTARY PUBLIC

yaebillias

4,
"”,
4%

My commission expires:

| ‘Check Numbe
Warrant/Check Nur " |3010158518

Reason for original issue of Warrant/Check (8): 3/12/24
O Payroll lan 7
O For Services or Goods furnished CO
O Treasurer’s refund/payment
Other: Rental Assistance - Maria Morales Sotelo - Func 22% - dened) @Y" asso

DAr~V-pPrymael See yr ces

Date: February 21, 2024

|, Cathy Perry, authorize Rose Hernandez, Subsidy
Coordinator, to execute an affidavit/claim for re-issuance of a
lost or stale-date check (warrant) on behalf of Viviendas
Scottsdale Apartments, JLVIV LLC. Managed and operated by
Bliven Property Management

Sincerely,

— ma eeeea ell a —
Designated Broker

ae:

counryexrensewareant TREASURER OF MARICOPA COUNTY — WARRANT NUMBER

PHOENIX, ARIZONA 3010158518
DATE
08-17-2023 9t-2/1224
Three Thousand And 00/160 Dollars
HEO $3,000.00
PAY TO T RDER OF
AMOUNT
JLVIV LLC
Viviendas Scottsdale Apartments Void Aer
365 Days
For Questions - 602-506-1379 or email AP@MAIL.MARICOPA.GOV NOT NEGOTIABLE
MARICOPA COUNTY DEPARTMENT OF FINANCE
RETAIN THIS FOR | PAYEE. WARRANT NO. | WARRANT DATE | WARRANT AMOUNT
YOUR, RECORDS
JLVLV LLC _. 3010158518 08/17/2023 $3,000.00
OICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
lINV-0000617054  |MORALES SOTELO, MARIA - RENTAL ASSISTA |GAX1D D220 240000002530 ~~ 3,000.00

240000002530

Noe @o0 ot

“¥ issued werrarts (Unsaved fitert
O Agency Status Warrantnumber — Issued date Paid date Arneunt
ovoisesg + | « ~ .

~  lesued

811742023 12:00:00 am _

3010158518

) Warrant number 2010198518

Amount Payee Account

3,000,00 JLVIV LLC | |