STAMPED & REDACTED - FOR AGENDA ATTACHMENT - MYNRD MANAGMENT INC.PDF

MAR COPA
COUNTY

Office of Budget & Finance
301 W. Jefferson St., 9" Floor
Phoenix, Arizona 85003

P: 602-506-3561
F: 602-506-4451

To: Clerk of the Board

From: — Office of Budget & Finance, Accounts Payable
Date: 01,05.24

Subject: Affidavit — MYND Management Inc

Maricopa.gov

Please find-attached-one-Affidavit for-a-duplicate- 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: D220 Human Services~ Fund 222—-GAX1D 24*6528- Thomas, Bria- Rental Assistance

Application for a Duplicate or Stale-Dated Warrant/Check

Affidavit/Claim Form
This application is for: 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.

MYND MANAGEMENT INC (1), being first sworn, Upon oath deposes and says:

Name/Ciaimant

On or about 4 8-Oct-2023 (date)(2) a warrant/check was issued to the
above narned person/entity in the amount as stated below. Such warrant/check was

either never received or was subsequeiitly iWadvertently 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

Ane him/her in the sum of $.1 919.51 3)
Signed: _ (4)

Note: Please attach a copy of the warrant/check if available and/or any other
avidence that a warrant/check was originally issued.

(5) Subscribed and sworn to before me this 2 day of Derembe 2023.

NOTAB PUBLIC a

My commission expires:

O3-a3- 9026

STEPHANIE LYNN ENGEL
NOTARY PUBLIG - ARIZONA
i Maricopa County

e : Commission # 634157
SH My Comm, Exp, Sep. 23, 2026 (seal)

Warrant/Check Number 13949163640 |

(if known) (6)
Original Date of Issue
(if known) (7) 18-Oct-2023

1/05/2024
Reason for original issue of Warrant/Check (8):
C Payroll

CO For Services or Goods furnished

(0 Treasurer's refund/payment
[J Other: 0220 HUMAN SERVICES FUND 222 GAX{(D 24°6528 - THOMAS, BRIA - RENTAL ASSISTANCE

ChUNTY EXPENSE WARRANT TREASURER OF MARICOPA COUNTY WARRANT NUMBER
fp signe
DATE

PHOENIX, ARIZONA 30107163640
f: ABT ZONK 74
() Bers | (| = 91-2/1221
re

One Thousand Nine Hundred Nineteen And 51/100 Dollars

$1,919.54

PAY TO THE ORDER OF
AMO
MYND MANAGEMENT INC UNT

Void After
365 Days

For Questions - 602-506-1379 or email AP@MAT.. MARICOPA.GOV, NOT NEGOTIABLE

MARICOPA COUNTY DEPARTMENT OF FINANCE

RETAIN THIS FOR | PAYEE, WARRANT NO. | WARRANT DATE | WARRANT AMOUNT

YOUR RECORDS

MYND MANAGEMENT INC 3010163640 10/18/2023 $1,919.51
INVOICE NUMBER | DESCRIPTION PURCHASE ORDER NO. | VOUCHER NO. AMOUNT
INV-0000620632 THOMAS, BRIA - RENTAL ASSISTANCE GAX1D D220 240000006528 41,919.51

240000006528

PROORREY MAD

Date: 12/28/2023

To Whom This May Concern:

|, Lizette Wardlaw, authorize Melissa Overton, Resident Experience
Manager, to execute an affidavit on behalf of Mynd Property
Management Inc.

Sincerely,

Migette Wandlaw
Lizette Wardlaw

Regional Manager
(E) Lizette. Wardlaw@Mynd.co