REDACTED - FOR AGENDA ATTACHMENT- CHOLLA RANCH APARTMENTS.PDF

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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: 02.22.24
Subject: Affidavit — Cholla Ranch Apartments

Please find attached one Affidavit for a stale dated 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 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*13175 & 23*13289-HIGAREDA
OTILIA & SMITH, JOSHUA — RENTAL ASSISTANCE

Application for a Duplicate or Stale-Dated Warrant/Check
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

bade 2 of this form.
CHOLLA RANCH APARTMENTS (1), being first sworn, upon oath deposes and says:
Name/Ciaimant

On or about 16-Dec-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, 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/che¢ ne issued to him/her in the sum of $ 19,740.71 3)
Signed; (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 wie to before me this_=><* * ‘day of fe. {

FE pO

‘NOTARY PUBLIC

NOVENA BANKS

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Sotery Pubtie S atte

comm. Expires 01-28-2025
“naw Notary iD 132898072

My commission expires:

ONS anes (seal)

Warrant/Check Number 3010137196

(if known) (6)

Original Date of Issue

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

1 Treasurer’s refund/payment

Other: Fund 222 -.D220 HUMAN SERVICES - GAX1D 23°f3175 & 23°13289- HIGAREDA OTILIA & SMITH, JOSHUA - RENTAL ASSISTANCE

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SEHOLLA RANCH

January 26, 2024

!
|, Rachel Johnson, authorize Lauren Allen, Regional Manager, to execute an affidavit for Maricopa
County on behaif of Cholla Ranch Apartments of Westlake Housing.

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Thank you, . :

Pecine L- th wy

Rachel Johnson

PHOENIX, ARIZONA,

TF RERSORER OF MARICOPA COUNTY WARRANT NUMBERS

3010137196

DATE
31

P| ™

Nineteen Thousand Seven Hundred Forty And 74/400 Dollars

PAY TO THE ORDER OF
CHOLLA RANGH APARTMENTS

Void Atier cnad
385 Days “3
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2-806-£379 oy email ABOMAIL. MARICOEA.GO¥

'Y DEPARTMENT OF FINANCE

NOT NEGOTIABLE

RETAIN TIS FOR | PAVEE

YOUR RECORDS

WARHANT NO. | WARRANT DATE | WARRANT AMOUNT

CHOLLA RANCH APARTMENTS

3010137196 12/16/2022 I 319,746.71

INVOICE NUMBER j | DESCRIPTION PURCHASE ORDER NO, | VOUCHER NO, AMOUNT

INV-0000586364 HIGAREDA OTILIA - RENTAL ASSISTANCE GAX1D 0226 230000012175 1,532.00
236000073175

INV-0000586365 HIGAREDA OTILIA - RENTAL ASSISTANCE GAX1D 2220 230008013176 3,925.81
230000013175

INV-0060587270 SMITH, JOSHUA » RENTAL ASSISTANCE GAX1D 0220 230000013289 3,276.00)
230000013289

INV-00G0587274 SMITH, JOSHUA - RENTAL ASSISTANCE GAXID D220 230900013289 74,006.06)
230000073268

varrants (Unsaved f

(1 Agency Status : Warrant number _ Issued date Paid date Arriount
. y 2010137196 + ¥ « .
12000 Stale 3010137196 = 12/16/2822 12:06:00 am 25/2... 1874071 i
Warrant number 3010137186
Amount Payee Account
18,740.71 WWHCF CHOLLA RANCH LP 210100-..,